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A cluster randomised controlled trial of the effect of a treatment algorithm for hypertension in patients with type 2

Charlotte Bebb1, Denise Kendrick, Carol Coupland

  • 1Renal Unit, City Hospital Campus, Nottingham University Hospitals, Hucknall Road, Nottingham. charlotte.bebb@nuh.nhs.uk

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|February 1, 2007
PubMed

Insights

A blood pressure (BP) treatment algorithm did not improve BP control in type 2 diabetes patients in primary care. Increased monitoring and medication did not lead to better outcomes, suggesting specialist care improvements may not transfer to primary settings.

Area of Science:

  • Cardiology
  • Endocrinology
  • Primary Care Medicine

Background:

  • Effective blood pressure (BP) control is crucial for reducing complications in type 2 diabetes patients.
  • Many individuals with type 2 diabetes struggle to achieve recommended BP targets.
  • Current hypertension management guidelines advocate for escalating antihypertensive medications, but their effectiveness in routine primary care is not well-established.

Purpose of the Study:

  • To assess the efficacy of a structured BP treatment algorithm for managing hypertension in primary care patients with type 2 diabetes.
  • To compare the outcomes of an algorithm-guided approach versus usual care in this patient population.

Main Methods:

  • A cluster randomized controlled trial involving 1534 patients with type 2 diabetes across 42 UK primary care practices.
  • Practices were randomized to either usual care or an intervention group utilizing a BP treatment algorithm.
  • The algorithm guided practice nurses and GPs in escalating antihypertensive therapy to achieve a target BP of 140/80 mmHg.

Main Results:

  • No significant difference in the proportion of patients achieving target BP at 1 year between the intervention and control groups (36.6% vs. 34.3%, P = 0.27).
  • Mean systolic and diastolic BP levels were identical in both groups (143/78 mmHg).
  • The intervention group showed a higher rate of BP-related primary care consultations (rate ratio = 1.55, P<0.001) and potentially higher medication doses without a significant increase in drug variety.

Conclusions:

  • Implementing a BP treatment algorithm in primary care did not enhance BP control for patients with type 2 diabetes, despite increased monitoring and medication adjustments.
  • Findings suggest that treatment improvements observed in specialist nurse-led secondary care settings may not be directly transferable to primary care environments for this population.
Abstract

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