Therapyresistant Uncontrolled Hypertension Primary Care Therapieresistent Ongecontrolleerd Hypertensie Eerste lijn
Conditions
Interventions
Trained GP's will execute a protocol involving a stepwise approach. The first step will be 24-hour blood pressure messurement to exclude white coat hypertension. Depending on how many steps a patient
Sponsors
UMC Utrecht
Eligibility
Inclusion criteria
Inclusion criteria: Patients aged > 18 years and 140/90 mmHg, on at least two blood pressure measurements per visit and on at least two occasions in the last year despite prescription of three or more blood pressure lowering drugs of different classes at adequate dosage, with for each antihypertensive drug at least 1 prescription of 3 months. During the inclusion consultation, the office blood pressure should be > 140/90 mmHg (measured according to the NHG CVRM guideline).
Exclusion criteria
Exclusion criteria: - A short life expectancy (< 6 months) as judged by the GP. - Inability to understand or conform to the stepwise protocol. - Unwillingness to provide a written informed consent. - In case of suspicion of a hypertensive crisis (systolic blood pressure ≥ 200 mmHg and/or diastolic blood pressure ≥ 120 mmHg) the patient is referred for further evaluation. If a hypertensive crisis is excluded, the patient can be included in the study. - Atrial fibrillation (because of difficulties to interpret 24 hour BP measurements) - Pregnancy or breast feeding. - Severe co-morbidity, which seriously interferes with diagnostic procedures or possible treatment.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary outcome is difference in 24-hour systolic BP between groups at 8 months follow-up. | — |
Secondary
| Measure | Time frame |
|---|---|
| - The percentage of patients with an office BP ≤ 140/90 or a mean 24-hour BP ≤130/80 mmHg, measured at the endpoint (8 months). - The time window (time from baseline) to reach a controlled BP during the study, defined as twice an office BP of ≤140/90 mmHg, or a mean 24-hours BP of ≤130/80 mmHg. - The number and/or dosage needed of BP lowering drugs, measured during the study time. - Referral to the medical specialist during the study time. - Health care use and associated costs during the study period or bp control/bp related events. - Quality of life as measured with the EQ5D and EQ-VAS at baseline and at the endpoint (8 months). - Cost-effectiveness of the intervention expressed in terms of cost per patient reaching adequate BP level and cost per Quality Adjusted Life Year Gained. - Self-reported BMI | — |
Contacts
Public ContactB. Kilic
Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde. Divisie, Afdeling, Huispostnummer: stratenum 5.122
Outcome results
None listed