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Narrowing the Gap in Hypertension: Effectiveness of a Complex Antihypertensive Program in the Elderly

机译：缩小高血压的差距：老年人复杂的降压计划的有效性

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Hypertension control is a difficult goal to achieve in common practice even when its benefits have been widely proved. We assessed the effectiveness of a Complex Antihypertensive Intervention Program in the Elderly (CAPE). A program trial of 500 elderly hypertensive patients was conducted. 250 were followed by primary care physicians and intervened by the CAPE and 250 received usual care. The program included an organizational change with the addition of an office where patients had their blood pressure measured, were appointed to join educational sessions and received verbal and printed advice before medical attendance. Data was systematically recorded in the electronic medical record which functioned as a physician reminder during the visit. Differences in systolic blood pressure level and in percentage of well-controlled ( < 140/90 mm Hg) patients between groups were measured after 12 months of follow-up. The difference of mean change in systolic blood pressure between groups was 7.1 mm Hg (95% confidence interval, 4-10 mm Hg). Sixty-seven percent of patients in the intervention group were well-controlled, as were 51% of patients in the control group ( p < 0.001). Patients who attended educational sessions showed the lowest odd ratio (0.25; 95% confidence interval, 0.11-0.54) for blood pressure above 140/90 mm Hg in multivariate analysis after adjusting for age, sex, initial systolic blood pressure level, and changes in antihypertensive treatment. These results support the effectiveness of our complex intervention program. Routine clinical care of hypertension can be improved with simple strategies that go beyond phar-macotherapy, tending to overcome clinical inertia.
机译：即使已经证明了高血压的益处，在常规实践中高血压控制也是一个难以实现的目标。我们评估了老年人综合降压干预计划（CAPE）的有效性。进行了500名老年高血压患者的计划试验。 250名患者接受了初级保健医生的治疗，并由CAPE进行了干预，其中250名接受了常规护理。该计划包括组织变更，并增加了一个办公室，负责测量患者的血压，任命他们参加教育课程，并在就诊之前接受口头和书面建议。数据被系统地记录在电子病历中，该电子病历在访问期间起到医师提醒的作用。随访12个月后，测量两组之间的收缩压水平和控制良好的患者（<140/90 mm Hg）百分比的差异。两组之间收缩压的平均变化差异为7.1 mm Hg（95％置信区间为4-10 mm Hg）。干预组中有67％的患者受到良好控制，对照组中有51％的患者受到良好控制（p <0.001）。校正年龄，性别，初始收缩压水平和血压变化后，参加多元分析的血压高于140/90 mm Hg的患者的奇数比最低（0.25； 95％置信区间为0.11-0.54）。降压治疗。这些结果证明了我们复杂的干预计划的有效性。高血压的常规临床治疗可以通过简单的策略来改善，这些策略不仅可以进行药物治疗，还可以克服临床惯性。

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