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Article: Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study

TitleEffects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study
Authors
KeywordsCardiovascular disease risk
Hypertension
Primary care
Risk assessment
Risk management
Risk stratification
Issue Date2017
PublisherLippincott Williams & Wilkins, Ltd. The Journal's web site is located at http://www.jhypertension.com/
Citation
Journal of Hypertension, 2017, v. 35 n. 3, p. 627-636 How to Cite?
AbstractObjectives: This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention. Methods: A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables. Results: Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk <=20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = -0.44, P < 0.01). Conclusion: The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.
Persistent Identifierhttp://hdl.handle.net/10722/237024
ISSN
2017 Impact Factor: 4.099
2015 SCImago Journal Rankings: 2.193
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYu, YTE-
dc.contributor.authorWan, YF-
dc.contributor.authorWong, CKH-
dc.contributor.authorChan, KC-
dc.contributor.authorChan, KH-
dc.contributor.authorHo, SY-
dc.contributor.authorKwok, RLP-
dc.contributor.authorLam, CLK-
dc.date.accessioned2016-12-20T06:15:03Z-
dc.date.available2016-12-20T06:15:03Z-
dc.date.issued2017-
dc.identifier.citationJournal of Hypertension, 2017, v. 35 n. 3, p. 627-636-
dc.identifier.issn0263-6352-
dc.identifier.urihttp://hdl.handle.net/10722/237024-
dc.description.abstractObjectives: This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention. Methods: A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables. Results: Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk <=20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = -0.44, P < 0.01). Conclusion: The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.-
dc.languageeng-
dc.publisherLippincott Williams & Wilkins, Ltd. The Journal's web site is located at http://www.jhypertension.com/-
dc.relation.ispartofJournal of Hypertension-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectCardiovascular disease risk-
dc.subjectHypertension-
dc.subjectPrimary care-
dc.subjectRisk assessment-
dc.subjectRisk management-
dc.subjectRisk stratification-
dc.titleEffects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study-
dc.typeArticle-
dc.identifier.emailYu, YTE: ytyu@hku.hk-
dc.identifier.emailWan, YF: yfwan@hku.hk-
dc.identifier.emailWong, CKH: carlosho@hku.hk-
dc.identifier.emailChan, KC: kcchanae@hku.hk-
dc.identifier.emailChan, KH: khychan4@hku.hk-
dc.identifier.emailHo, SY: soki0721@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.authorityYu, YTE=rp01693-
dc.identifier.authorityWan, YF=rp02518-
dc.identifier.authorityWong, CKH=rp01931-
dc.identifier.authorityLam, CLK=rp00350-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1097/HJH.0000000000001177-
dc.identifier.pmid27861244-
dc.identifier.pmcidPMC5278886-
dc.identifier.scopuseid_2-s2.0-84995745412-
dc.identifier.hkuros270689-
dc.identifier.volume35-
dc.identifier.issue3-
dc.identifier.spage627-
dc.identifier.epage636-
dc.identifier.isiWOS:000393822200028-
dc.publisher.placeUnited Kingdom-

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