Saturday, March 28, 2009
bloeddruk hypertension
Simplified hypertension management strategy proposed
27 March 2009
MedWire News: A simplified antihypertensive treatment algorithm involving an initial low-dose, fixed-dose combination is superior to guideline-based management of uncomplicated hypertension, Canadian researchers have found.
According to the findings, this algorithm is “implementable, changes physician-prescribing patterns, and results in better blood pressure control than conventional guideline-based care,” the team writes in the journal Hypertension.
Ross Feldman (Robarts Research Institute, London, Ontario) and colleagues note that poor patient adherence to multidrug regimens contribute to the well-documented treatment gap in patients with hypertension.
Furthermore, “therapeutic inertia,” whereby practitioners fail to escalate the intensity of therapy despite poorly controlled hypertension, is an issue. “We speculate that the increasingly complex treatment regimens currently advocated by experts, national guidelines, and the pharmaceutical industry might contribute to this undesirable behavior,” they write.
In light of these barriers, they developed the Simplified Treatment Intervention to Control Hypertension (STITCH) – a simple, step-care–based algorithm.
The study included 45 single-physician practices randomly assigned to treat patients according to STITCH care or to usual management of patients according to the Canadian Hypertension Education Program (CHEP) guidelines.
Data for a total of 2104 patients with uncontrolled hypertension treated at these practices were available for analysis, of whom 49% were already being treated at baseline.
Patients assigned to STITCH care were more likely to reach target blood pressure levels, with 64.7% achieving target levels at 6 months compared with 52.7% of those assigned to guideline care (p=0.026).
The STITCH group also had greater reductions in systolic and diastolic blood pressure levels, at means of 22.6 versus 17.5 mmHg (p=0.002) and 10.4 versus 8.2 mmHg (p=0.03), respectively.
The STITCH care patients were prescribed more individual drugs (2.3 vs 1.9 drugs, p<0.001), consistent with greater use of fixed-dose combinations in this group.
They also tended to have fewer standard doses prescribed than in the guideline care group (1.7 versus 2.0, p=0.06), but a greater proportion were uptitrated (82.6% vs 69.6%, p=0.007).
The authors comment that the six-fold increase in use of fixed-dose combination drugs by the STITCH-care physicians in comparison with guideline care practices shows that the implementation process changed physician behavior.
“Furthermore, STITCH-care physicians reported greater satisfaction with their management of hypertension, suggesting that STITCH care is a practicable strategy for use by community physicians,” they write.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
Hypertension 2009; 95: 577–583
27 March 2009
MedWire News: A simplified antihypertensive treatment algorithm involving an initial low-dose, fixed-dose combination is superior to guideline-based management of uncomplicated hypertension, Canadian researchers have found.
According to the findings, this algorithm is “implementable, changes physician-prescribing patterns, and results in better blood pressure control than conventional guideline-based care,” the team writes in the journal Hypertension.
Ross Feldman (Robarts Research Institute, London, Ontario) and colleagues note that poor patient adherence to multidrug regimens contribute to the well-documented treatment gap in patients with hypertension.
Furthermore, “therapeutic inertia,” whereby practitioners fail to escalate the intensity of therapy despite poorly controlled hypertension, is an issue. “We speculate that the increasingly complex treatment regimens currently advocated by experts, national guidelines, and the pharmaceutical industry might contribute to this undesirable behavior,” they write.
In light of these barriers, they developed the Simplified Treatment Intervention to Control Hypertension (STITCH) – a simple, step-care–based algorithm.
The study included 45 single-physician practices randomly assigned to treat patients according to STITCH care or to usual management of patients according to the Canadian Hypertension Education Program (CHEP) guidelines.
Data for a total of 2104 patients with uncontrolled hypertension treated at these practices were available for analysis, of whom 49% were already being treated at baseline.
Patients assigned to STITCH care were more likely to reach target blood pressure levels, with 64.7% achieving target levels at 6 months compared with 52.7% of those assigned to guideline care (p=0.026).
The STITCH group also had greater reductions in systolic and diastolic blood pressure levels, at means of 22.6 versus 17.5 mmHg (p=0.002) and 10.4 versus 8.2 mmHg (p=0.03), respectively.
The STITCH care patients were prescribed more individual drugs (2.3 vs 1.9 drugs, p<0.001), consistent with greater use of fixed-dose combinations in this group.
They also tended to have fewer standard doses prescribed than in the guideline care group (1.7 versus 2.0, p=0.06), but a greater proportion were uptitrated (82.6% vs 69.6%, p=0.007).
The authors comment that the six-fold increase in use of fixed-dose combination drugs by the STITCH-care physicians in comparison with guideline care practices shows that the implementation process changed physician behavior.
“Furthermore, STITCH-care physicians reported greater satisfaction with their management of hypertension, suggesting that STITCH care is a practicable strategy for use by community physicians,” they write.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
Hypertension 2009; 95: 577–583
# posted by roodbont @ 1:41 AM 
