221 EffectS of a multifaceted intervention on the Cardiovascular risk fActors in high risk hyPErtensive patients in primary prevention (ESCAPE Trial)

Abstract

To show that a multifaceted intervention, aimed at general practitioners (GP), can improve high risk hypertensive patients’ health outcomes, without affecting their quality of life. Cluster randomized trial. The intervention consisted of one day of medical education, aiming on the therapeutic targets and strategies for achievement featured in the French guidelines, an electronic blood pressure (BP) measurement device, a short leaflet summarizing the guidelines, 4 prevention-dedicated consultations in 2 years, and a feedback on IG patients’ results at baseline and at 1 year follow-up. Patient's inclusion criteria: hypertensive patients with at least 2 other cardiovascular risk factors in primary prevention. Primary end point: number of patients achieving all the targets featured in the guidelines. Secondary end points: number of patients achieving each target, variation of the value of the targets, and quality of life (SF-8). 128 GPs were randomized as clusters in the intervention group (IG), and 131 in the control group (CG). GPs have included 1 832 hypertensive patients, 1 047 of them had type 2 diabetes. 1 823 patients were analyzed at 2 years. The number of patients reaching all their targets increased by 3.54% in the CG, and 6.57% in the IG (p < 0.02). The number of patients reaching their BP targets increased by 3.7% in the CG, and by 13.8% in the IG (p < 0.01). Systolic BP decreased by 1.5 mmHg in the CG and by 6.3 mmHg in the IG (p < 0.001). Diastolic BP decreased by 1.4 mmHg in the CG and 3.5 mmHg in the IG (p < 0.05). Change in quality of life was similar in the 2 groups. A multifaceted intervention aimed at GPs improves high risk hypertensive patients’ health outcomes without affecting their quality of life.