Improving control of hypertension by an integrated approach ??? results of the ???Manage it well!??? programme

Abstract

Patient non-compliance is a significant contributor to poor blood pressure control. Although measures to improve compliance are known, they are not in routine use. To apply measures based on current recommendations in an integrated approach in the 'Manage it well!' (MIW) programme, and to determine the improvement in blood pressure control. During the prospective open cohort study, 348 primary and 156 secondary care centres enrolled 6941 hypertensive patients and followed them for 6 months. An integrated intervention package also applicable to everyday practice was introduced to improve treatment adherence, including education programmes for patients and physicians, tight follow-up with frequent office visits and regular home blood pressure measurements. Treatment was based on either trandolapril or verapamil SR with dose titration, with added-on therapy if necessary. Rates of control of blood pressure to < 140/90 mmHg. Data were evaluated from 5468 patients, 72% known to have hypertension and 26% newly diagnosed [2% not available (n.a.)]. At baseline only 2.9% of treated patients had their hypertension well controlled (< 140/90 mmHg), but during the programme this increased to 40.9% (P < 0.001). The absolute reduction in office blood pressure was also significant (from 168 +/- 19/97 +/- 11 mmHg to 139 +/- 13/83 +/- 7 mmHg; P < 0.001). No differences in blood pressure control were found between trandolapril and verapamil SR regimens. Office blood pressure was greater than home blood pressure at baseline (168 +/- 19/97 +/- 11 mmHg compared with 151 +/- 17/89 +/- 10 mmHg; P < 0.001), but this difference disappeared at 6 months (139 +/- 13/83 +/- 7 mmHg compared with 140 +/- 13/84 +/- 7 mmHg, respectively). The integrated, patient-focused approach used in the MIW programme significantly increases the success of treatment in a 'real-world' setting.