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clinmed/2002120002v1 (February 13, 2003)
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Narrowing the gap in Hypertension: Efficacy of a Complex Antihypertensive Intervention Program in the Elderly – (CAIPE).
Silvana Figar, Gabriel Waisman, Fernan Gonzalez Bernaldo de Quiros, Carlos Galarza, Marcelo Marchetti, Gabriela Rodriguez Loria, Luis Camera, Daniel Seinhart, and Mario Camera
Objectives To assess the efficacy of a Complex Antihypertensive Intervention Programme in the Elderly.
Design Quasi experimental programme trial.
Setting Ambulatory care of a university-associated teaching hospital.
Participants Hypertensive patients aged 65 years or over, 246 followed by clinicians were intervened and 212 followed by family physicians recieved usual care. A computer–based monitoring system was used for patient recruitment. Mean follow-up was 11 months.
Intervention the programme included an organizational change with the addition of an office where patients had their blood pressure measured, were appointed to join educational sessions and received verbal and printed advice before medical attendance. Data was systematically recorded in the elecronic medical chart acting as a physician reminder during the visit.
Main outcome measures Difference in systolic blood pressure level and in percentage of well-controlled (<140/90 mm Hg) patients between groups.
Results The difference of mean change in systolic blood pressure between groups was 8.4 mm Hg (95% confidence interval 5 to 11 mm Hg). Percentage of well-controlled patients was 66% in intervention group and 47% in controls (p<0.001). Multivariate analysis showed an odds ratio of 0.25 (95% confidence interval 0.11 to 0.54) for blood pressure above 140/90 mm Hg in patients who received the intervention, after adjusting for age, sex, initial systolic blood pressure level and changes in antihypertensive treatment.
Conclusions These results support the efficacy of our complex intervention programme. Routine clinical care of hypertension can be improved with simple strategies that go beyond pharmacotherapy, tending to overcome clinical inertia.