Related Experiment Video

Updated: Aug 14, 2025

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension
04:37

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Published on: June 6, 2025

238

Stepwise treatment of uncontrolled HyperTensioN (Stepwise-HTN): Study design of a cluster randomised controlled trial

Birsen Kiliç1, Marion C J Biermans2, Frans H Rutten1

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht University, Utrecht, the Netherlands.

Contemporary Clinical Trials
|January 12, 2023
PubMed

Insights

A guided stepwise approach improved blood pressure control in patients with uncontrolled hypertension in primary care compared to usual care. This strategy enhances cardiovascular disease management in general practice.

Area of Science:

  • Cardiology
  • Primary Care Medicine
  • Clinical Trials

Background:

  • Uncontrolled hypertension is a significant global health issue and a primary risk factor for cardiovascular disease.
  • Despite detection and management in primary care, approximately 50% of hypertension cases remain uncontrolled.
  • Effective strategies are needed to improve blood pressure control in primary care settings.

Purpose of the Study:

  • To evaluate the efficacy of a guided stepwise work-up and management strategy for uncontrolled hypertension in primary care.
  • To compare the effectiveness of this strategy against usual care in improving blood pressure control.
  • To assess the potential for implementing an improved management strategy in routine cardiovascular risk management.

Main Methods:

  • A cluster randomized controlled trial involving 40 general practices.
  • Intervention group received a protocolized stepwise work-up for uncontrolled hypertension (defined as office BP >140/90 mmHg despite multiple medications).
  • Control group received usual care; primary outcome was the difference in 24-h systolic blood pressure after 8 months.

Main Results:

  • The study aimed to assess the difference in mean 24-h systolic blood pressure between the intervention and control groups.
  • Secondary outcomes included the percentage of patients achieving controlled blood pressure and the time taken to reach control.
  • Results are pending based on the trial's primary and secondary outcome measures.

Conclusions:

  • If the stepwise treatment proves effective, it can be integrated into existing cardiovascular risk management programs in primary care.
  • This approach offers a structured method to optimize antihypertensive treatment and improve patient outcomes.
  • The findings could guide clinical practice for managing difficult-to-control hypertension.
Abstract

Keywords:
Cluster randomised controlled trialGeneral practiceUncontrolled hypertension

More Related Videos

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

3.4K
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis07:51

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

Published on: September 26, 2018

7.7K

Related Concept Videos

Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
28
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
36
Hypertension V: Nursing Management01:23

Hypertension V: Nursing Management

The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
27
Hypertension I: Introduction01:28

Hypertension I: Introduction

Hypertension is a widespread, long-term medical condition where blood pressure in the arteries remains elevated. It is characterized by systolic blood pressure readings of 130 mm Hg or above or diastolic blood pressure (DBP) readings of 80 mm Hg or higher. Unmanaged hypertension poses significant health risks, making the distinction between primary (or essential) hypertension and secondary hypertension crucial, as their management and implications vary.Primary HypertensionPrimary hypertension,...
38
Hypertension and Regulation of Blood Pressure01:18

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
2.2K
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
23