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Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension
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STEPWISE management of clinically apparent resistant hypertension in primary care: a cluster randomised controlled

Birsen Kiliç1, Marion C J Biermans2, Michiel L Bots3

  • 1Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

BMC Primary Care
|July 3, 2025
PubMed

Insights

A structured approach to managing resistant hypertension in primary care did not significantly lower blood pressure compared to usual care. This study found no significant differences in 24-hour or office systolic blood pressure between the groups.

Area of Science:

  • Cardiology
  • Primary Care Medicine
  • Clinical Trials

Background:

  • Clinically apparent resistant hypertension (CARH) is a prevalent condition associated with increased cardiovascular event risk.
  • Effective management strategies for CARH in primary care are crucial for patient outcomes.
  • This study addresses the need for evidence-based approaches to control difficult-to-manage hypertension.

Purpose of the Study:

  • To evaluate the effectiveness of a stepwise management strategy for CARH in primary care.
  • To compare blood pressure control in patients receiving a structured intervention versus usual care.
  • To determine if a pragmatic, stepwise approach improves outcomes for resistant hypertension patients.

Main Methods:

  • A pragmatic, cluster-randomised controlled trial (cRCT) involving 106 patients across 22 general practitioner practices.
  • Patients had office blood pressure >140/90 mmHg despite three or more antihypertensive medications.
  • The intervention included 24-hour BP monitoring, assessment of BP-raising compounds, lifestyle, compliance, medication optimization, and specialist referral when needed.

Main Results:

  • No significant difference in 24-hour systolic blood pressure (136.9 mmHg vs. 132.6 mmHg, p=0.15) or office systolic blood pressure (146.1 mmHg vs. 147.6 mmHg, p=0.51) at 8 months.
  • Similar rates of controlled hypertension (22% vs. 28%) and number of prescribed BP-lowering medications (2.98 vs. 3.11) between the intervention and usual care groups.
  • The stepwise approach did not yield statistically significant improvements in blood pressure control.

Conclusions:

  • A pragmatic, structured stepwise approach for managing CARH in primary care does not appear to be more effective than usual care.
  • Further research may be needed to identify optimal strategies for resistant hypertension management in primary care settings.
  • The findings suggest that current usual care may be as effective as the tested stepwise intervention for this patient group.
Abstract

Keywords:
AntihypertensivesCardiovascular diseaseCardiovascular riskClinically apparent resistant hypertensionCluster randomised controlled trialGeneral practiceHypertensionLifestylePreventionPrimary care

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