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Community care compared with hospital outpatient care for hypertensive patients
Insights
Specialist care for hypertension patients showed slightly better blood pressure control than general practice over two years. However, referring well-controlled patients back to general practitioners is a sensible policy for managing mild to moderate hypertension.
Area of Science:
- Cardiology
- Public Health
- General Practice
Background:
- Hypertension management requires ongoing care.
- The effectiveness of general practice versus specialist care for treated hypertension patients is a key area of research.
- Patient adherence and treatment continuity are crucial for long-term blood pressure control.
Purpose of the Study:
- To compare the effectiveness of continued specialist hypertension care versus referral to general practitioners for managing treated outpatients.
- To assess blood pressure control and patient follow-up in two different care settings.
- To determine if general practice care is a viable alternative for selected hypertension patients.
Main Methods:
- Randomized controlled trial involving 376 patients with treated hypertension.
- Patients were allocated to either two years of hospital outpatient care or referral to their general practitioners.
- Blood pressure measurements and follow-up adherence were monitored over two years.
Main Results:
- Both groups showed minimal changes in average lying blood pressure.
- A statistically significant average fall of 1.6 mm Hg in standing diastolic pressure was observed in the hospital group, versus a 1.4 mm Hg rise in the general practice group (p < 0.05).
- Adherence to follow-up was slightly higher in the general practice group (94% vs 90%), but treatment discontinuation was higher (9 patients vs 3 patients).
Conclusions:
- Continued specialist supervision offered marginally better blood pressure control compared to general practice care in this selected group of treated hypertensive patients.
- Referral of well-controlled hypertension patients back to general practitioners is a practical and sensible approach.
- The findings support the integration of general practitioners in long-term hypertension management for stable patients.
Abstract:
Three hundred and seventy-six patients with treated diastolic blood pressures of less than 105 mm Hg and no history of accelerated hypertension or renal failure were selected from among those attending the Hammersmith Hospital hypertension clinic. Their average lying treated blood pressure was 146 mm Hg systolic and 90 mm Hg diastolic and average age 56 years; 18% were black, 6% Asian, and 76% white. The patients were mostly having multiple treatment, 90% receiving a diuretic, 35% methyldopa, 33% propranolol, 18% atenolol, 9% hydrallazine, and 7% bethanidine. They were randomly allocated to either two years of further hospital outpatient care or referred back to their general practitioners. During the two years 19 (10%) of the 187 patients followed up in hospital defaulted and three had their treatment discontinued. Twelve (6%) of the 189 followed up by their general practitioners defaulted from follow-up and nine had their treatment discontinued. At the end of the trial the average lying blood pressure was 148 mm Hg systolic and 88 mm Hg diastolic in the hospital group and 149 mm Hg systolic and 90 mm Hg diastolic in the general practice group. The change in blood pressure was calculated for each individual and showed an average fall of 1.6 mm Hg in standing diastolic pressure in the hospital group and a rise of 1.4 mm Hg in the general practice group (p less than 0.05). The 90% confidence limits for a difference in standing diastolic pressure between the groups were 1 and 5 mm Hg with the pressure lower in the hospital group. General practice care was not quite as effective in controlling blood pressure as continued specialist supervision over two years in this selected group of treated outpatients with mild or moderate hypertension, but these results show that the discharge back to general practitioners of patients who are well controlled after hospital treatment is a sensible policy.