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 , * Open Modal Authors Info & Affiliations
The Open Cardiovascular Medicine Journal 5 May 2009 RESEARCH ARTICLE DOI: 10.2174/1874192400903010026


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. [ NCT00416611].

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