Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/89724
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Type: Journal article
Title: More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care: results from the Valsartan Intensified Primary carE Reduction of Blood Pressure study
Author: Stewart, S.
Stocks, N.
Burrell, L.
de Looze, F.
Esterman, A.
Harris, M.
Hung, J.
Swemmer, C.
Kurstjens, N.
Jennings, G.
Carrington, M.
Citation: Journal of Hypertension, 2014; 32(6):1342-1350
Publisher: Lippincott, Williams & Wilkins
Issue Date: 2014
ISSN: 0263-6352
1473-5598
Statement of
Responsibility: 
Simon Stewart, Nigel P. Stocks, Louise M. Burrell, Ferdinandus J. de Looze, Adrian Esterman, Mark Harris, Joseph Hung, Carla H. Swemmer, Nicol P. Kurstjens, Garry L. Jennings, Melinda J. Carrington, on behalf of the VIPER-BP Study Investigators
Abstract: OBJECTIVE: To examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics and 1562 randomized participants. METHODS: Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1-5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up. RESULTS: Mean age was 59.3 ± 12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132 ± 14/79 ± 9 and 51% to 141 ± 15/83 ± 11  mmHg and 19% in those participants subject to the highest (n = 270, 26%) versus least (n = 148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15-1.31; for achieving BP target (P < 0.001). Participants with a per protocol score of 4 or 5 (512/1038, 49.3%) were 1.54-fold (95% CI 1.31-1.81; P < 0.001) more likely to achieve their individual BP target compared with usual care. Clinics equipped with a practice nurse significantly influenced protocol adherence (adjusted RR 1.20, 95% CI 1.06-1.37; P = 0.004) and individual BP control (RR 1.21, 95% CI 1.04-1.41; P = 0.015). CONCLUSION: There is considerable potential for structured care management to improve BP control in primary care, especially when optimally applied.
Keywords: antihypertensive treatment; blood pressure; cardiovascular disease; hypertension; management; primary care; treatment targets
Rights: © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
DOI: 10.1097/HJH.0000000000000180
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General Practice publications

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