Lowering blood pressure in primary care in Vienna (LOW-BP-VIENNA): A cluster-randomized trial

Miklos Rohla, Maximilian Tscharre, Kurt Huber, Thomas W Weiss

Research output: Journal article (peer-reviewed)Journal article

2 Citations (Scopus)

Abstract

BACKGROUND: In Austria only 41% of patients with treated hypertension (HTN) have their blood pressure (BP) controlled. This study investigated a strategy to improve BP control in primary care.

METHODS: General practitioners (GPs) were randomized to interventional care vs. standard care and included patients with uncontrolled office BP > 140/90 mm Hg. In interventional care, antihypertensive therapy was up-titrated using a single pill combination (olmesartan, amlodipine and/or hydrochlorothiazde) in 4‑week intervals. In standard care, physicians were encouraged to treat according to the 2013 European Society of Cardiology guidelines for the management of arterial hypertension. The primary endpoint was the proportion of patients with controlled office BP < 140/90 mm Hg at 6 months. The main secondary endpoint was the improvement in 24 h ambulatory BP (ABPM, Clinicaltrials.gov NCT02377661).

RESULTS: Between 2015-2017, 20 GPs contributed to patient recruitment. The trial was discontinued due to slow recruitment after inclusion of 139 eligible patients, 54 of whom were included in the interventional group. A significantly larger proportion of patients in interventional vs. standard care achieved the office BP target (67% ± 26% vs. 39% ± 29%, respectively, mean difference -27.9%, 95% confidence interval CI -54.0%; -1.7%, p = 0.038). The proportion of patients with controlled 24 h ABPM (<130/80 mm Hg) was similar between groups (49% ± 33% vs. 40% ± 34%, respectively, mean difference -8.8%, 95% CI -40.7%; 23.1%, p = 0.57). At baseline, pretreated patients received an average of 1.5 ± 0.8 vs. 1.7 ± 0.9 antihypertensive prescriptions. At 6 months, the respective BP reductions were achieved with 1.2 ± 0.5 prescriptions in interventional vs. 2.0 ± 1.0 in standard care (p < 0.01).

CONCLUSION: In both groups statistically and clinically significant BP reductions were observed after 6 months. In the interventional care group, a larger proportion of patients achieved the office BP target compared to standard care. The 24 h ambulatory blood pressure levels were controlled in 44% of patients at 6 months, without significant differences between groups. The respective BP reductions were achieved with a significantly lower medication burden in interventional care.

Original languageEnglish
Pages (from-to)698-706
Number of pages9
JournalWiener Klinische Wochenschrift
Volume130
Issue number23-24
DOIs
Publication statusPublished - 1 Dec 2018
Externally publishedYes

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents
  • Austria
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory
  • Female
  • Humans
  • Hypertension
  • Middle Aged
  • Primary Health Care
  • Prospective Studies
  • Young Adult
  • Single pill combination drugs
  • Hypertension control
  • Ambulatory blood pressure measurement
  • Disease management programs
  • Arterial hypertension

ASJC Scopus subject areas

  • Medicine (all)

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