Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups

Abstract

The Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative (HMI) was a pragmatic implementation of clinical practice guidelines for hypertension management in primary care clinics. The HMI was a prospective delayed phase cohort study of 11 sites enrolling patients in two blocks starting 9 months apart in 2007. The intervention was an evidence-informed chronic disease management program consisting of an interprofessional educational intervention with practice tools to implement the Canadian Hypertension Education Program’s clinical practice guidelines. This study compares the change in blood pressure (BP) from baseline to 9 months after the intervention between groups. In the immediate intervention group, the mean BP at baseline was 134.6/79.1 mm Hg (18.2/11.5) and in the delayed intervention group 134.2/77.1 mm Hg (18.9/11.8). The fall in BP in the immediate intervention group from baseline to 9 months after the intervention was 7.3/3.6 mm Hg (95% confidence interval (CI): 5.9–8.7/2.6–4.5) and in the delayed group 8.1/3.3 mm Hg (95% CI: 7.0–9.3/2.5–4.1) (all P<0.0001 were compared from baseline to the end of 9 months of the program in both groups). This study is the first to demonstrate that implementation of an interprofessional knowledge integration initiative for the control of hypertension can rapidly lead to lower BP levels.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  1. Public Health Agency of Canada. High Blood Pressure in Canada; 2010. Available from http://www.phac-aspc.gc.ca/feature-vedette/cardio/hbp-ha-eng.php.

  2. Robitaille C, Dai S, Waters C, Loukine L, Bancej C, Quach S et al. Diagnosed hypertension in Canada: incidence, prevalence and associated mortality. Can Med Assoc J 2012; 184 (1): E49–E56.

    Article  Google Scholar 

  3. Leenen FH, Schiffrin EL . Control rates of hypertension in North America. Hypertension 2010; 56 (4): 571–572.

    CAS  Article  Google Scholar 

  4. Campbell NR, Petrella R, Kaczorowski J . Public education on hypertension: a new initiative to improve the prevention, treatment and control of hypertension in Canada. Can J Cardiol 2006; 22 (7): 599–603.

    CAS  Article  Google Scholar 

  5. Petrella RJ, Campbell NR . Awareness and misconception of hypertension in Canada: results of a national survey. Can J Cardiol 2005; 21 (7): 589–593.

    PubMed  Google Scholar 

  6. McInnis NH, Fodor G, Lum-Kwong MM, Leenen FH . Antihypertensive medication use and blood pressure control: a community-based cross-sectional survey (ON-BP). Am J Hypertens 2008; 21 (11): 1210–1215.

    CAS  Article  Google Scholar 

  7. Health Canada. A Framework for Collaborative Pan-Canadian Health Human Resources Planning 2012.

  8. Antikainen RL, Kastarinen MJ, Jousilahti P, Peltonen M, Laatikainen T, Beckett N et al. Despite evidence-based guidelines, systolic blood pressure remains inadequately controlled in older hypertensive adults. J Hum Hypertens 2010; 24 (7): 439–446.

    CAS  Article  Google Scholar 

  9. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T . Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev 2010 (3): CD005182.

  10. Gallagher J, de Lusignan S, Harris K, Cates C . Quality-improvement strategies for the management of hypertension in chronic kidney disease in primary care: a systematic review. Br J Gen Pract. 2010; 60: e258–e265.

  11. McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010; 376 (9736): 163–172.

    Article  Google Scholar 

  12. Tobe S, Lum-Kwong M, Perkins N, Von Sychowski S, Sebaldt R, Kiss A . Heart and Stroke Foundation of Ontario (HSFO) high blood pressure strategy’s hypertension management initiative study protocol. BMC Health Serv Res 2008; 8 (1): 251.

    Article  Google Scholar 

  13. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA 2002; 288 (15): 1882–1888.

    Article  Google Scholar 

  14. A fifth amendment for the Declaration of Helsinki. Lancet 2000; 356 (9236): 1123.

  15. World Medical Association, Saif M . Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 1997; 277 (11): 925–926.

    Article  Google Scholar 

  16. World Medical Association. Declaration of Helskinki—ethical principles for medical research involving human subjects; 2011. Available from: http://www wma net/en/30publications/10policies/b3/index html pdf?print-media-type&footer-right=[page]/[toPage].

  17. Cuspidi C, Michev I, Meani S, Severgnini B, Sala C, Salerno M et al. Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy. J Hum Hypertens 2003; 17 (8): 541–547.

    CAS  Article  Google Scholar 

  18. Cuspidi C, Sampieri L, Macca G, Michev I, Fusi V, Salerno M et al. Improvement of patients’ knowledge by a single educational meeting on hypertension. J Hum Hypertens 2001; 15 (1): 57–61.

    CAS  Article  Google Scholar 

  19. Mattu GS, Heran BS, Wright JM . Overall accuracy of the BpTRU—an automated electronic blood pressure device. Blood Press Monit 2004; 9 (1): 47–52.

    Article  Google Scholar 

  20. Myers MG, McInnis NH, Fodor GJ, Leenen FHH . Comparison between an automated and manual sphygmomanometer in a population survey. Am J Hypertens 2008; 21 (3): 280–283.

    Article  Google Scholar 

  21. Karwalajtys T, Kaczorowski J, Hutchison B, Myers MG, Sullivan SM, Chambers LW et al. Blood pressure variability and prevalence of hypertension using automated readings from multiple visits to a pharmacy-based community-wide programme. J Hum Hypertens 2009; 23 (9): 585–589..

    CAS  Article  Google Scholar 

  22. Hackam DG, Khan NA, Hemmelgarn BR, Rabkin SW, Touyz RM, Campbell NR et al. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2—therapy. Can J Cardiol 2010; 26 (5): 249–258.

    CAS  Article  Google Scholar 

  23. Quinn RR, Hemmelgarn BR, Padwal RS, Myers MG, Cloutier L, Bolli P et al. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1—blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol 2010; 26 (5): 241–248.

    Article  Google Scholar 

  24. Pylypchuk G, Vincent L, Wentworth J, Kiss A, Perkins N, Hartman S et al. Diabetes risk evaluation and microalbuminuria (DREAM) studies: ten years of participatory research with a first nation’s home and community model for type 2 diabetes care in Northern Saskatchewan. Int J Circumpolar Health 2008; 67 (2–3): 190–202.

    Article  Google Scholar 

  25. Myers MG, Godwin M, Dawes M, Kiss A, Tobe SW, Grant FC et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ 2011; 342: d286.

    Article  Google Scholar 

  26. Weir MR, Zappe D, Orloski LA, Sowers JR . How early should blood pressure control be achieved for optimal cardiovascular outcomes? J Hum Hypertens 2011; 25 (4): 211–217.

    CAS  Article  Google Scholar 

  27. Roumie CL, Elasy TA, Greevy R, Griffin MR, Liu X, Stone WJ et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med 2006; 145 (3): 165–175.

    Article  Google Scholar 

  28. Al-Windi A . Detection and treatment of hypertension in general health-care practice: a patient-based study. J Hum Hypertens 2005; 19 (10): 775–786.

    CAS  Article  Google Scholar 

  29. Leenen FH, Dumais J, McInnis NH, Turton P, Stratychuk L, Nemeth K et al. Results of the Ontario survey on the prevalence and control of hypertension. CMAJ 2008; 178 (11): 1441–1449.

    Article  Google Scholar 

  30. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW et al. Expressing the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate with Standardized Serum Creatinine Values. Clin Chem 2007; 53 (4): 766–772.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the contributions of the Ontario College of Family Physicians, the Registered Nurses’ Association of Ontario (RNAO) and the Ontario Pharmacists’ Association as key partners of the HSFO in this initiative. We thank the health-care providers and patients in the 11 HMI sites for their participation in the program. The HMI was developed and led by the HSFO, with pilot (alpha phase) funding provided by the Ministry of Health and Long-Term Care, Ontario, through the Primary Health Care Transition Fund (PHCTF).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S W Tobe.

Ethics declarations

Competing interests

Dr Sheldon W Tobe has received research grants from the HSFO and the Canadian Institute for Health Research. He has received investigator-initiated funding for research as well as participated in contract research and received honoraria from companies that manufacture antihypertensives. Margaret Moy Lum-Kwong, Shirley Von Sychowski and Kishan Kandukur are employed by the HSFO. Dr Alex Kiss and Virginia Flintoft declare no potential conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tobe, S., Moy Lum-Kwong, M., Von Sychowski, S. et al. Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups. J Hum Hypertens 28, 44–50 (2014). https://doi.org/10.1038/jhh.2013.48

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.48

Keywords

  • primary care
  • chronic disease management program
  • interprofessional education
  • clinical practice guidelines
  • patient self-management

Search

Quick links