Both hypertensive men and women are inadequately treated in Finnish general practice

Personalized text message and checklist support for initiation of antihypertensive medication: the cluster randomized, controlled check and support trial

Objective: To assess whether the use of a checklist combined with text message support improves systolic blood pressure (SBP) control.Design and setting: A cluster randomized controlled trial in Finnish primary care.Interventions: Personalized text message support and a checklist for initiation of antihypertensive medication.Patients: 111 newly diagnosed hypertensive patients aged 30-75 years.Main outcome measures: The proportion of patients achieving 1) the office SBP target <140 mmHg or 2) the home SBP target <135 mmHg at 12 months.Results: 28% (n = 16) and 31% (n = 17) of patients in the intervention and control groups met the office SBP target, respectively (p = 0.51). The corresponding proportions were 36% (n = 18) and 42% (n = 21) for the home SBP target (p = 0.21). Office SBP decreased 23 mmHg (95% CI: 29-17) in the intervention group and 21 mmHg (95% CI: 27-15) in the control group (p = 0.61). Medication changes, number of antihypertensives at 12 months and health care utilization were similar in both study groups. Patients considered checklist and text message support useful and important.Conclusion: Only a small proportion of patients in the intervention and control groups reached their treatment target despite multiple health care contacts and medication changes. The study interventions did not improve SBP control. However, this study demonstrates new information about hypertension control, antihypertensive medication and health service utilization during the first treatment year.

Feasibility of a checklist in treating hypertension in primary care - base line results from a cluster-randomised controlled trial (check and support)

Background

Most 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.

Methods

The 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.

Results

In 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.

Conclusions

Even 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 registration

NCT02377960. Date of registration: February 26th, 2015.