Document Detail

A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial.
MedLine Citation:
PMID:  19237683     Owner:  NLM     Status:  MEDLINE    
Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7% versus 52.7%; absolute difference: 12.0%; 95% CI: 1.5% to 22.4%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.
Ross D Feldman; Guang Y Zou; Margaret K Vandervoort; Cindy J Wong; Sigrid A E Nelson; Brian G Feagan
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-02-23
Journal Detail:
Title:  Hypertension     Volume:  53     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-20     Completed Date:  2009-04-22     Revised Date:  2010-05-28    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  646-53     Citation Subset:  IM    
Robarts Research Institute, 100 Perth Dr, London, Ontario N6A 5K8, Canada.
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MeSH Terms
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Diuretics / therapeutic use
Drug Therapy, Combination
Family Practice*
Hypertension / drug therapy*,  epidemiology
Middle Aged
Patient Compliance
Risk Factors
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Diuretics
Comment In:
Curr Hypertens Rep. 2010 Jun;12(3):146-8   [PMID:  20424948 ]
Hypertension. 2009 Apr;53(4):598-9   [PMID:  19237677 ]
J Clin Hypertens (Greenwich). 2009 May;11(5):292-95   [PMID:  19534038 ]

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