%0 Journal Article %1 Feldman2009 %A Feldman, Ross D. %A Zou, Guang Y. %A Vandervoort, Margaret K. %A Wong, Cindy J. %A Nelson, Sigrid A. E. %A Feagan, Brian G. %D 2009 %J Hypertension %K algorithm hta treatment %N 4 %P 646--653 %R 10.1161/HYPERTENSIONAHA.108.123455 %T A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial. %U http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.123455 %V 53 %X Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7\% versus 52.7\%; absolute difference: 12.0\%; 95\\ CI: 1.5\% to 22.4\%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20\% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.

@article{Feldman2009, abstract = {{Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7\% versus 52.7\%; absolute difference: 12.0\%; 95\\ CI: 1.5\% to 22.4\%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20\% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.}}, added-at = {2023-02-03T11:40:24.000+0100}, author = {Feldman, Ross D. and Zou, Guang Y. and Vandervoort, Margaret K. and Wong, Cindy J. and Nelson, Sigrid A. E. and Feagan, Brian G.}, biburl = {https://www.bibsonomy.org/bibtex/215603535b4b93bdea60faace21e58f24/jepcastel}, citeulike-article-id = {6385140}, citeulike-linkout-0 = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.123455}, doi = {10.1161/HYPERTENSIONAHA.108.123455}, institution = {Robarts Research Institute, 100 Perth Dr, London, Ontario N6A 5K8, Canada. Ross.Feldman@lhsc.on.ca}, interhash = {1eb362d5a0a96c59cc7c106aa99a2aee}, intrahash = {15603535b4b93bdea60faace21e58f24}, journal = {Hypertension}, keywords = {algorithm hta treatment}, month = apr, number = 4, owner = {jep}, pages = {646--653}, posted-at = {2009-12-15 10:58:36}, priority = {2}, timestamp = {2023-02-03T11:41:54.000+0100}, title = {{A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial.}}, url = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.123455}, volume = 53, year = 2009 }