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


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.

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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).

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Correspondence to S W Tobe.

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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.

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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).

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


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