RESEARCH ARTICLE


Implementation of Guidelines for the Management of Arterial Hypertension. The Impulsion Study



Asterios Karagiannis1, Apostolos I Hatzitolios2, Vasilios G Athyros1, Kalliopi Deligianni3, Charalambos Charalambous4, Christos Papathanakis5, Georgios Theodosiou6, Theodoros Drakidis7, Veronika Chatzikaloudi7, Chysanthi Kamilali7, Sotirios Matsiras8, Athanasios Matziris9, Christos Savopoulos2, Maria Baltatzi2, Jobst Rudolf10, Konstantinos Tziomalos11, Dimitri P Mikhailidis11, *
1 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
2 First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
3 Department of Internal Medicine, Katerini Hospital, Katerini, Greece
4 Department of Internal Medicine, Phychiatric Hospital, Thessaloniki, Greece
5 Health Centre of Orestiada, Orestiada, Greece
6 Department of Internal Medicine, Edessa Hospital, Edessa, Greece
7 Health Centre of Sidirokastro, Sidirokastro, Greece
8 Health Centre of Chalastra, Chalastra, Greece
9 Health Centre of Langadas, Langadas, Greece
10 Stroke Unit, Department of Neurology, Papageorgiou Hospital, Thessaloniki, Greece
11 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College Medical School, University College London, Pond Street, London, UK


© Karagiannis et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Clinical Biochemistry, Royal Free Hospital Campus, University College Medical School, University College London, Pond Street, London NW3 2QG, UK; Tel: +44 20 7830 2258; Fax: +44 20 7830 2235; E-mail: mikhailidis@aol.com
# All authors listed at the end of the article in the Co-investigators section.


Abstract

This study assessed the effects of a pilot best practice implementation enhancement program on the control of hypertension. We enrolled 697 consecutive known hypertensive patients with other vascular risk factors but free from overt vascular disease. There was no “control” group because it was considered unethical to deprive high-risk patients from “best medical treatment”. Following a baseline visit, previously trained physicians aimed to improve adherence to lifestyle measures and drug treatment for hypertension and other vascular risk factors. Both at baseline and at study completion (after 6 months), a 1-page form was completed showing if patients achieved treatment targets. If not, the reasons why were recorded. This program enhanced compliance with lifestyle measures and increased the use of evidence-based medication. There was a substantial increase in the number of patients who achieved treatment targets for blood pressure (p<0.0001) and other vascular risk factors. In non-diabetic patients (n=585), estimated vascular risk (PROCAM risk engine) was significantly reduced by 41% (p<0.0001). There was also a 12% reduction in vascular risk according to the Framingham risk engine but this did not achieve significance (p=0.07). In conclusion, this is the first study to increase adherence to multiple interventions in hypertensive patients on an outpatient basis, both in primary care and teaching hospitals. Simple, relatively low cost measures (e.g. educating physicians and patients, distributing printed guidelines/brochures and completing a 1-page form) motivated both physicians and patients to achieve multiple treatment goals. Further work is needed to establish if the improvement observed is sustained. [ClinicalTrials.gov NCT00416611].

Key Words: Hypertension, treatment, control, best practice, vascular risk factors..