Abstract
BackgroundSeveral observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets.MethodsA pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients’ clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life.Results1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups.ConclusionAn easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets.Trial registrationThis trial was registered with ClinicalTrials.gov, number NCT00348855
Highlights
Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice
As these patients are at an increased cardiovascular risk, the recommendations set targets for low-density lipoprotein cholesterol (LDL), smoking cessation, and, in patients with type-2 diabetes, Glycated hemoglobin (HbA1c) and low-dose aspirin treatment [2]
Attendance at the one-day training in the intervention group or the 90 minute-meeting in the usual care group was mandatory for general practitioners (GPs) to include patients
Summary
Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. French [1,2] and European [3] guidelines for the primary prevention of cardiovascular complications in patients with hypertension are mainly based on blood pressure targets that should be achieved along with other riskreducing strategies. As these patients are at an increased cardiovascular risk, the recommendations set targets for low-density lipoprotein cholesterol (LDL), smoking cessation, and, in patients with type-2 diabetes, HbA1c and low-dose aspirin treatment [2]. The more risk factors that hypertensive patients receiving primary prevention treatment have, the worse these risk factors are controlled [5,9,10]
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