Outpatient Treatment Management in a Hypertensive Population

Objective: To increase the rates of blood pressure control in a hypertensivepopulation, we assessed optimal and scientific measures for outpatient treatmentmanagement.Methods: subjects: in regimen group46patients with hypertension visitedhypertension clinic in Dalian Central Hospital from June2005to October2009，and incontrol group37patients with hypertension who have been prescribing incardiovascular medicine clinic for two or more than two years were investigated.Patient Selection: patients met the following criteria in regimen group: had not beenprescribed or had drug withdrawal for more than two weeks at first visit with primaryhypertension, over18years old,no limitedto gender,based on systolicBP(SBP)≥150mmHg or diastolic BP(DBP)≥95mmHg,had normal serum creatinine, notumor and vital organ dysfunction.patients in control group had been prescribed for twoor more than two year for primary hypertension,other criterial are identical to those usedin regimen group. Agents selection in regimen group: physicians chose drugsrecommended by Chinese Hypertention Clinical Guideline2005as initial drug and drugcombination(calcium channel blocker、diuretic、 beta blocker、ACE inhibitor andangiotensin receptor blocker),used regular dosage consistent with the Guideline,considered individual status. Follow-UP:six weeks before,patients should be seen attwo weeks intervals, physicians maintained the previous medicine management if theblood pressure goal was reached or BP reduced10%, if not physicians increased thenumber or dosage of medications. Six weeks after,after blood pressure is at goal,follow-up visits were scheduled at1to3months intervals, if not visits were scheduledat2weeks intervals. Goal BP: the goal of treatment is to reduce blood pressure to below140mmHg systolic and90mmHg diastolic; in patients with diabetes, the goal is bloodpressure below130/80mmHg；in patients over65years old, the goal is blood pressure below150/90mmhg. Evaluation: height、weight、BMI、blood pressure、blood lipid andblood glucose. Rates of blood pressure control and therapy intensity for evaluatinghypertension management. Cognitive level and treatment behavior related tohypertension education.Results: the baseline characteristics of both groups are comparable with respect togender and age（P>0.05）. Compared to control group, standard1：11.9%、33.3%、52.4%、88.1%；standard2：14.3%、38.1%、61.9%、100.0%；standard3：11.9%、28.6%、52.4%、95.2%patients in regimen group achieved significantly higher rates ofBP control,medication adherence was signicicantly better in the regimen group（P<0.05）,there was higher rates of choosing three and four drug combination andlower rates of choosing two drugs and single drug in regimen group when compared tothe control group（P<0.05）,78%patients in regimen groups were prescribed diuretics. Inthe regimen group physicians changed medications22、17、15and5times in each visit.Conclusions: this study showed that current antihypertensive agents are potent tocontrol blood pressure completely, to obtain the effective control of blood pressure,physicians should use these measures:1to follow hypertension management regimen.2to choose antihypertensives consistent with therapy guideline and to consider individualstatus.3to improve hypertension education.