Efficacy of protocol-based blood pressure management in the outpatient settings

Despite established guidelines, blood pressure(BP) control remains suboptimal worldwide. Poor implementation of guidelines is identified as a contributing factor. "Protocol-based BP management(PB-BPM)" is a suggested solution and has been implemented in Sri Lanka. However, data on the efficacy of PB-BPM are sparse in South Asia. We assessed the efficacy of PB-BPM in the outpatient clinics of the primary and secondary/tertiary healthcare facilities in Sri Lanka by analysing BP data of those with 6 or more months' follow-up by 31^st December 2025. Controlled BP was defined as <140/90 mmHg per the WHO guideline. We compared mean BP and the percentage with controlled BP between baseline and the end of follow-up. BP control of 13097 patients (male 3480(26.6%, mean age 64( ± 10.2) were studied. Mean systolic BP(SBP p < 0.001), diastolic BP(DBP p < 0.001), and the percentage with controlled BP (p < 0.001) improved significantly at follow-up compared to baseline. Mean reduction in SBP/ DBP was more in primary compared to secondary/tertiary care facilities (p < 0.001/ p < 0.001), with high baseline SBP(r = 0.671, p < 0.001) and DBP(r = 0.639, p < 0.001). In conclusion, PB-BPM improved BP control among outpatients managed at state hospitals in Sri Lanka, with greater efficacy observed in primary healthcare facilities and among patients with high baseline BP.