Lack of Impact of a Comprehensive Intervention on Hypertension in the Primary Care Setting

Niiranen, Teemu J.; Leino, Kimmo; Puukka, Pauli; Kantola, Ilkka; Karanko, Hannu; Jula, Antti

doi:10.1093/ajh/hpt204

Cited by 27 publications

(16 citation statements)

References 28 publications

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“…It is acknowledged that addressing long-term behaviour change is difficult in primary care, 58 and that a lack of motivation and incentives may hinder trials on novel lifestyle interventions. 59 Our trial recruited from the community, but medical supervision and communications with primary care physicians was part of the safety management, and provided insights into translation.…”

Section: Discussionmentioning

confidence: 99%

Effect of interdisciplinary care on weight loss: a randomised controlled trial

et al. 2017

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ObjectiveTo determine the effectiveness of a novel interdisciplinary treatment compared with usual care on weight loss in overweight and obese adult volunteers.DesignSingle blinded controlled trial. Participants randomly assigned to usual care (C, general guideline-based diet and exercise advice), intervention (I, interdisciplinary protocol) or intervention + a healthy food supplement (30 g walnuts/day) (IW).SettingCommunity based study, Illawarra region, south of Sydney, Australia.ParticipantsGenerally well volunteer adult residents, 25-54 years, body mass index (BMI) 25-40kg/m2 were eligible. At baseline 439 were assessed, 377 were randomised, 298 completed the 3-month intensive phase and 178 completed the 12-month follow-up.InterventionsTreatment was provided at clinic visits intensively (0 months, 1 month, 2 months, 3 months) then quarterly to 12 months. Support phone calls were quarterly. All participants underwent blinded assessments for diet, exercise and psychological status.Primary and secondary measuresThe primary outcome was difference in weight loss between baseline and 12 months (clinically relevant target 5% loss). Secondary outcomes were changes in blood pressure, fasting blood glucose and lipids, and changes in diet, exercise and psychological parameters.ResultsAt 12 months, differences in weight loss were identified (p<0.001). The I group lost more than controls at 3 months (91.11 (92.23,90.00), p<0.05) and the IW more than controls at 3 months (91.25 (92.35,90.15), p<0.05) and 6 months (92.20 (93.90,90.49), p<0.01). The proportion achieving 5% weight loss was significantly different at 3 months, 6 months and 9 months (p=0.04, p=0.03, p=0.03), due to fewer controls on target at 3 months, 6 months and 9 months and more IW participants at 6 months. Reductions in secondary outcomes (systolic blood pressure, blood glucose/lipid parameters and lifestyle measures) followed the pattern of weight loss.ConclusionsAn interdisciplinary intervention produced greater and more clinically significant and sustained weight loss compared with usual care. The intensive phase was sufficient to reach clinically relevant targets, but long-term management plans may be required.Trial registration numberANZCTRN 12614000581662; Post-results.

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Section: Discussionmentioning

confidence: 99%

Effect of interdisciplinary care on weight loss: a randomised controlled trial

et al. 2017

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“…In conclusion, a significant group difference in BP reduction, with a prespecified alpha of 0.05 (for a 2-tailed test) and power of 0.80, was not observed when comparing a practice-based multicomponent intensive lifestyle intervention vs. a single-session individual counseling on lifestyle modification among a sample of Blacks with uncontrolled hypertension. Based on these findings and those of others, [24][25][26][27][28] we contend that the implementation of pragmatic single-session interventions, as an alternative to intensive multicomponent interventions, and its effects on utilization of healthcare services should be further evaluated in this high-risk population. This is particularly important in the era of the Affordable Care Act that demands a parsimonious use of healthcare resources, while achieving significant improvement in quality of care at reduced costs.…”

Section: Discussionmentioning

confidence: 55%

Comparative Effectiveness of a Practice-Based Comprehensive Lifestyle Intervention vs. Single Session Counseling in Hypertensive Blacks

Schoenthaler

Luerassi

Silver

et al. 2015

AJHYPE

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“…We also call for more studies investigating BP target setting in real life primary care settings. Although certain interventions have been demonstrated to work in academic settings, these findings may not apply in primary care [35].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a checklist in treating hypertension in primary care – base line results from a cluster-randomised controlled trial (check and support)

Tahkola

Korhonen

Kautiainen

et al. 2018

BMC Cardiovasc Disord

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BackgroundMost patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence.MethodsThe study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n = 4) or control sites (n = 4). We included patients aged 30–75 years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol.ResultsIn total, 119 patients were included in the study, of which 118 were included in the analysis (n = 59 in the control group, n = 59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention.ConclusionsEven highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem.Trial registrationNCT02377960. Date of registration: February 26th, 2015.

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Lack of Impact of a Comprehensive Intervention on Hypertension in the Primary Care Setting

Abstract: NCT01915199.

Cited by 27 publications

References 28 publications

Effect of interdisciplinary care on weight loss: a randomised controlled trial

Effect of interdisciplinary care on weight loss: a randomised controlled trial

Comparative Effectiveness of a Practice-Based Comprehensive Lifestyle Intervention vs. Single Session Counseling in Hypertensive Blacks

Feasibility of a checklist in treating hypertension in primary care – base line results from a cluster-randomised controlled trial (check and support)

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