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.
%0 Journal Article
%1 Feldman2009
%A Feldman, Ross D.
%A Zou, Guang Y.
%A Vandervoort, Margaret K.
%A Wong, Cindy J.
%A Nelson, Sigrid A. E.
%A Feagan, Brian G.
%D 2009
%J Hypertension
%K algorithm hta treatment
%N 4
%P 646--653
%R 10.1161/HYPERTENSIONAHA.108.123455
%T A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial.
%U http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.123455
%V 53
%X 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.
@article{Feldman2009,
abstract = {{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.}},
added-at = {2023-02-03T11:40:24.000+0100},
author = {Feldman, Ross D. and Zou, Guang Y. and Vandervoort, Margaret K. and Wong, Cindy J. and Nelson, Sigrid A. E. and Feagan, Brian G.},
biburl = {https://www.bibsonomy.org/bibtex/215603535b4b93bdea60faace21e58f24/jepcastel},
citeulike-article-id = {6385140},
citeulike-linkout-0 = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.123455},
doi = {10.1161/HYPERTENSIONAHA.108.123455},
institution = {Robarts Research Institute, 100 Perth Dr, London, Ontario N6A 5K8, Canada. Ross.Feldman@lhsc.on.ca},
interhash = {1eb362d5a0a96c59cc7c106aa99a2aee},
intrahash = {15603535b4b93bdea60faace21e58f24},
journal = {Hypertension},
keywords = {algorithm hta treatment},
month = apr,
number = 4,
owner = {jep},
pages = {646--653},
posted-at = {2009-12-15 10:58:36},
priority = {2},
timestamp = {2023-02-03T11:41:54.000+0100},
title = {{A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial.}},
url = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.123455},
volume = 53,
year = 2009
}