Abstract

PurposeUncertainty exists regarding the best way to communicate cardiovascular risk (CVR) to patients, and it is unclear whether the comprehension and perception of CVR varies according to the format used. The aim of the present work was to determine whether a strategy designed for communicating CVR information to patients with poorly controlled high blood pressure (HBP), but with no background of cardiovascular disease, was more effective than usual care in the control of blood pressure (BP) over the course of a year.MethodsA pragmatic, two-arm, cluster-randomized controlled trial was performed. Consecutive patients aged 40–65 years, all diagnosed with HBP in the last 12 months, and all of whom showed poor control of their condition (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), were recruited at 22 primary healthcare centres. Eleven centres were randomly assigned to the usual care arm, and 11 to the informative intervention arm (Educore arm). At the start of the study, the Educore arm subjects were shown the "low risk SCORE table", along with impacting images and information pamphlets encouraging the maintenance of good cardiovascular health. The main outcome variable measured was the control of HBP; the secondary outcome variables were SCORE table score, total plasma cholesterol concentration, use of tobacco, adherence to prescribed treatment, and quality of life.ResultsThe study participants were 411 patients (185 in the Educore arm and 226 in the usual care arm). Multilevel logistic regression showed that, at 12 months, the Educore intervention achieved better control of HBP (OR = 1.57; 1.02 to 2.41). No statistically significant differences were seen between the two arms at 12 months with respect to the secondary outcomes.ConclusionsCompared to usual care, the Educore intervention was associated with better control of HBP after adjusting for age, baseline SBP and plasma cholesterol, at 12 months.

Highlights

  • Most Spanish patients with high blood pressure (HBP) are attended to at primary healthcare centres in the Spanish National Health System

  • Consecutive patients aged 40–65 years, all diagnosed with HBP in the last 12 months, and all of whom showed poor control of their condition, were recruited at 22 primary healthcare centres

  • The main outcome variable measured was the control of HBP; the secondary outcome variables were Systematic Coronary Risk Evaluation (SCORE) table score, total plasma cholesterol concentration, use of tobacco, adherence to prescribed treatment, and quality of life

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Summary

Introduction

Most Spanish patients with high blood pressure (HBP) are attended to at primary healthcare centres in the Spanish National Health System. This easy-access first level of assistance provides integrated and continuous care [1,2,3]. One randomized clinical trial [9] reported the skill of patients in identifying cardiovascular risk (CVR) factors to improve when communication was made personal. Other authors [10] have reported that medical professionals normally communicate these risks verbally, using words and or figures; they indicate, that controversy exists regarding the best way to communicate with patients, over whether verbal communication is improved with visual aids

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