Abstract
BackgroundMost patients with antihypertensive medication do not achieve their blood pressure (BP) target. The most important factor behind this failure is poor medication adherence. However, non-adherence to therapy does not concern only patients. Clinicians also tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control. The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence.MethodsThe study was conducted in eight primary care study centres in Central Finland, randomised to function as either intervention (n = 4) or control sites (n = 4). We included patients aged 30–75 years who were prescribed antihypertensive medication for the first time. Initiation of medication in the intervention group was carried out with a 9-item checklist, filled in together by the treating physician and the patient. Hypertension treatment in the control group was managed by the treating physician without a study-specific protocol.ResultsIn total, 119 patients were included in the study, of which 118 were included in the analysis (n = 59 in the control group, n = 59 in the intervention group). When initiating antihypertensive medication, an adequate BP target was set for 19% of the patients in the control group and for 68% in the intervention group. Shortly after the appointment, only 14% of the patients in the control group were able to remember the adequate BP target, compared with 32% in the intervention group. The use of the checklist was also related to more regular agreement on the next follow-up appointment (64% in the control group versus 95% in the intervention group). No adverse events or side effects were related to the intervention.ConclusionsEven highly motivated new hypertensive patients in Finnish primary care have significant gaps in their informational and behavioural skills. The use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills. Based on our findings, the use of a checklist might be a practical tool for addressing this problem.Trial registrationNCT02377960. Date of registration: February 26th, 2015.
Highlights
Most patients with antihypertensive medication do not achieve their blood pressure (BP) target
One patient was excluded from the study due to acute myocardial infarction before all Outcomes When initiating antihypertensive medication, the correct BP target was set for 19% of the patients in the control group and for 68% in the intervention group
In this randomised, controlled study we showed that even highly motivated new hypertensive patients in Finnish primary care have significant gaps in informational and behavioural skills and that the use of a checklist for initiation of antihypertensive medication was related to significant improvement in these skills
Summary
Most patients with antihypertensive medication do not achieve their blood pressure (BP) target. Clinicians tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control The aim of this non-blinded, cluster-randomised, controlled study was to investigate if using a checklist would improve the quality of care in the initiation of new antihypertensive medication and help reduce non-adherence. Most patients on antihypertensive medication do not achieve their blood pressure (BP) target in Finland [1], Europe [2] or worldwide [3] This results in a vast amount of preventable cardiovascular complications, especially in patients with other cardiovascular risk factors or prevalent heart disease [4, 5] BP control rates remain poor year after year, even though some clear improvements have been reported, for example from England [6]. Clinicians tend to lack adherence to hypertension guidelines, overestimate BP control and be satisfied with inadequate BP control [9,10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
