Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Effectiveness of multidisciplinary intervention on blood pressure control in primary health care: a randomized clinical trial

Authors: Regina Kuhmmer, Rosmeri Kuhmmer Lazzaretti, Cátia Moreira Guterres, Fabiana Viegas Raimundo, Leni Everson Araújo Leite, Tássia Scholante Delabary, Suhelen Caon, Gisele Alsina Nader Bastos, Carisi Anne Polanczyk

Published in: BMC Health Services Research | Issue 1/2016

Login to get access

Abstract

Background

Hypertension is a public health problem and a major risk factor for cardiovascular disease. The purpose of this study is to compare the effectiveness of a multidisciplinary program based on group and individual care versus group-only care, to promote blood pressure control in hypertensive patients in primary health care.

Methods

Randomized controlled clinical trial. The study was conducted within the primary health care, in two units of the Family Health Strategy, covering 11,000 individuals, in Porto Alegre, Brazil. Two hundred and 56 patients, older than 40 years old and with uncontrolled hypertension, systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg or ≥130 mmHg and/or diastolic BP ≥80 mmHg for individuals with diabetes. Eligible patients were randomly assigned to a health care program aiming for blood pressure control, with the multidisciplinary program group or with the multidisciplinary program plus personalized care group. Primary outcome measures were reduction in systolic BP from baseline to 6 months. Secondary measures included proportion of patients with systolic or diastolic BP controlled. Student t test, Pearson’s chi-squared test, Fisher’s exact test, Mann-Whitney U test, Wilcoxon signed-ranks test and generalized estimating equation (GEE) model were used in the analysis.

Results

The baseline characteristics of participants were similar between groups. After 6 months of follow-up, systolic BP decreased markedly in both groups (Δ - 11.8 mmHg [SD, 20.2] in the multidisciplinary program group and Δ - 12.9 mmHg [SD, 19.2] in the personalized care group; p < 0.001). Similarly, we noted a significant change in diastolic BP over time in both groups (Δ - 8.1 mmHg [SD, 10.8] in the multidisciplinary program group and Δ - 7.0 mmHg [SD, 11.5] in the personalized care group; p < 0.001).

Conclusions

The study demonstrates similar effectiveness of a group intervention in comparison to a personalized education program in hypertension patients to achieve BP control. These findings indicate that the intervention can be for all hypertensive patients assisted in primary health care.

Trial registration

ClinicalTrials.gov IdentifierNCT01696318 (May 2013).
Literature
1.
Committee ESoH-ESoCG. European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21(6):1011–53.CrossRef
2.
3.
World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011.
4.
MacMahon S, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. Clin Exp Hypertens. 1993;15(6):967–78.PubMedCrossRef
5.
Ogden LG, He J, Lydick E, Whelton PK. Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension. 2000;35(2):539–43.PubMedCrossRef
6.
Neal B, MacMahon S, Chapman N, Collaboration BPLTT. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2000;356(9246):1955–64.PubMedCrossRef
7.
Benetos A, Thomas F, Safar ME, Bean KE, Guize L. Should diastolic and systolic blood pressure be considered for cardiovascular risk evaluation: a study in middle-aged men and women. J Am Coll Cardiol. 2001;37(1):163–8.PubMedCrossRef
8.
Benetos A, Thomas F, Bean K, Gautier S, Smulyan H, Guize L. Prognostic value of systolic and diastolic blood pressure in treated hypertensive men. Arch Intern Med. 2002;162(5):577–81.PubMedCrossRef
9.
Pastor-Barriuso R, Banegas JR, Damián J, Appel LJ, Guallar E. Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med. 2003;139(9):731–9.PubMedCrossRef
10.
Onat A, Ceyhan K, Erer B, Başar O, Uysal O, Sansoy V. Systolic, diastolic, and pulse pressures as coronary risk factors in a population with low cholesterol levels: a prospective 10-year evaluation. Clin Cardiol. 2003;26(2):91–7.PubMedCrossRef
11.
Roumie CL, Elasy TA, Greevy R, Griffin MR, Liu X, Stone WJ, Wallston KA, Dittus RS, Alvarez V, Cobb J, et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med. 2006;145(3):165–75.PubMedCrossRef
12.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, et al. Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.PubMedCrossRef
13.
Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, McAlister FA, Johansen H, Baclic O, Campbell N. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3:e003423.PubMedPubMedCentralCrossRef
14.
Picon RV, Fuchs FD, Moreira LB, Riegel G, Fuchs SC. Trends in prevalence of hypertension in Brazil: a systematic review with meta-analysis. PLoS One. 2012;7(10):e48255.PubMedPubMedCentralCrossRef
15.
Pinho NA, Pierin AMG. Hypertension Control in Brazilian Publications. Arq Bras Cardiol. 2013;101(3):e65–7.PubMedCentral
16.
Nogueira D, Faerstein E, Coeli CM, Chor D, Lopes CS, Werneck GL. Awareness, treatment and control of arterial hypertension: Pro-Saude Study. Brazil Rev Panam Salud Publica. 2010;27(2):103–9.PubMed
17.
18.
Ministry of Health. Department of Health Care. Department of Primary Care. General Coordination of Food and Nutrition Policy. Food Guide of the Brazilian Population: Promoting healthy eating. Brazil: Brasilia: Ministry of Health; 2005.
19.
Ministry of Health. Ordinance No. 154 / GM of 24 January 2008. It provides for the creation of Nucleus of Support to Family Health Teams. Brazil: Brasilia: Ministry of Health; 2008.
20.
21.
Blasco PG, Levites MR, Janaudis MA, Moreto G, Roncoletta AF, de Benedetto MA, Pinheiro TR. Family medicine education in Brazil: challenges, opportunities, and innovations. Acad Med. 2008;83(7):684–90.PubMedCrossRef
22.
23.
Brazilian Society of Cardiology, Brazilian society of hypertension, Brazilian Society of Nephrology. VI Brazilian Guidelines on Hypertension. Arq Bras Cardiol. 2010;95(1 Suppl):1–51.
24.
Brazilian Society of Cardiology, Brazilian society of hypertension, Brazilian Society of Nephrology. V Guidelines for ambulatory blood pressure monitoring (ABPM) and III Guidelines for home blood pressure monitoring (HBPM)]. Arq Bras Cardiol. 2011;97(3 Suppl 3):1–24.
25.
26.
Hallal PC, Matsudo SM, Matsudo VK, Araújo TL, Andrade DR, Bertoldi AD. Physical activity in adults from two Brazilian areas: similarities and differences. Cad Saude Publica. 2005;21(2):573–80.PubMedCrossRef
27.
Barry KL, Fleming MF. The Alcohol Use Disorders Identification Test (AUDIT) and the SMAST-13: predictive validity in a rural primary care sample. Alcohol Alcohol. 1993;28(1):33–42.PubMed
28.
Babor TF, Higgins-Biddle JC. Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction. 2000;95(5):677–86.PubMedCrossRef
29.
Report of a WHO Consultation on Obesity. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization (WHO Technical Report Series, No. 894); 2000.
30.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.PubMedCrossRef
31.
Ben AJ, Neumann CR, Mengue SS. The Brief Medication Questionnaire and Morisky-Green test to evaluate medication adherence. Rev Saude Publica. 2012;46(2):279–89.PubMedCrossRef
32.
Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113–24.PubMedCrossRef
33.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef
34.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMed
35.
Sposito AC, Caramelli B, Fonseca FA, Bertolami MC, Afiune Neto A, Souza AD, Lottenberg AM, Chacra AP, Faludi AA, Loures-Vale AA, et al. IV Brazilian Guideline for Dyslipidemia and Atherosclerosis prevention: Department of Atherosclerosis of Brazilian Society of Cardiology. Arq Bras Cardiol. 2007;88 Suppl 1:2–19.PubMedCrossRef
36.
37.
Jafar TH, Hatcher J, Poulter N, Islam M, Hashmi S, Qadri Z, Bux R, Khan A, Jafary FH, Hameed A, et al. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med. 2009;151(9):593–601.PubMedCrossRef
38.
Jafar TH, Levey AS, Jafary FH, White F, Gul A, Rahbar MH, Khan AQ, Hattersley A, Schmid CH, Chaturvedi N. Ethnic subgroup differences in hypertension in Pakistan. J Hypertens. 2003;21(5):905–12.PubMedCrossRef
39.
McLean DL, Simpson SH, McAlister FA, Tsuyuki RT. Treatment and blood pressure control in 47,964 people with diabetes and hypertension: a systematic review of observational studies. Can J Cardiol. 2006;22(10):855–60.PubMedPubMedCentralCrossRef
40.
Guirado EA, Ribera EP, Huergo VP, Borras JM, Group A. Knowledge and adherence to antihypertensive therapy in primary care: results of a randomized trial. Gac Sanit. 2011;25(1):62–7.CrossRef
41.
Maruf FA, Akinpelu AO, Salako BL. Effects of aerobic exercise and drug therapy on blood pressure and antihypertensive drugs: a randomized controlled trial. Afr Health Sci. 2013;13(1):1–9.PubMedPubMedCentral
42.
Harris MF, Fanaian M, Jayasinghe UW, Passey ME, McKenzie SH, Powell Davies G, Lyle DM, Laws RA, Schütze H, Wan Q. A cluster randomised controlled trial of vascular risk factor management in general practice. Med J Aust. 2012;197(7):387–93.PubMedCrossRef
43.
Doucette WR, Witry MJ, Farris KB, McDonough RP. Community pharmacist-provided extended diabetes care. Ann Pharmacother. 2009;43(5):882–9.PubMedCrossRef
44.
Kramer MK, Kriska AM, Venditti EM, Miller RG, Brooks MM, Burke LE, Siminerio LM, Solano FX, Orchard TJ. Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery. Am J Prev Med. 2009;37(6):505–11.PubMedCrossRef
45.
Qureshi NN, Hatcher J, Chaturvedi N, Jafar TH, Group HR. Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial. BMJ. 2007;335(7628):1030.PubMedPubMedCentralCrossRef
Metadata
Title
Effectiveness of multidisciplinary intervention on blood pressure control in primary health care: a randomized clinical trial
Authors
Regina Kuhmmer
Rosmeri Kuhmmer Lazzaretti
Cátia Moreira Guterres
Fabiana Viegas Raimundo
Leni Everson Araújo Leite
Tássia Scholante Delabary
Suhelen Caon
Gisele Alsina Nader Bastos
Carisi Anne Polanczyk
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1703-0

Other articles of this Issue 1/2016

BMC Health Services Research 1/2016 Go to the issue

Erratum

Erratum to: Mortality and treatment costs of hospitalized chronic kidney disease patients between the three major health insurance schemes in Thailand

Research article

Factors related to non-compliance to HPV vaccination in Roraima—Brazil: a region with a high incidence of cervical cancer

Research article

Classification and rates of adverse events in a Malawi male circumcision program: impact of quality improvement training

Research article

Factors influencing health care and service providers’ and their respective “at risk” populations’ adoption of the Air Quality Health Index (AQHI): a qualitative study

Study protocol

Access to timely formal dementia care in Europe: protocol of the Actifcare (ACcess to Timely Formal Care) study

Research article

Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia