IMPLEMENTATION of a team-based multicomponent programme, as opposed to standard care, has demonstrated a decrease in the risk of cardiovascular disease (CVD) and mortality in patients with hypertension.
This research was of a population-based, prospective, matched cohort design, comparing usual care with the Risk Assessment and Management Program for Hypertension (RAMP-HT), an intervention combining treatment and evaluation from multiple specialties. Patients undergoing RAMP-HT received three services alongside usual care: nurse-led risk assessments every 12–30 months, as well as both nurse interventions, and specialist consultations where necessary.
After risk assessments, care plans were also logged using electronic health records. Esther Yu, University of Hong Kong, China, described the benefits of this “action reminder system accessible at any public primary care clinic to support team members clinical decision making.” Comparatively, participants receiving usual care had physician-led care every 8–16 weeks.
108,045 patents were assigned to the RAMP-HT group and 104, 662 to usual care, across 73 outpatient clinics in Hong Kong. All had uncomplicated hypertension and a mean age of 66 years. RAMP-HT participants had an 8.0% absolute risk reduction for CVD after 5 years, as well as a 1.6% absolute risk reduction for end-stage kidney disease, and a 10% absolute risk reduction for all-cause mortality.
Adjusting for baseline covariates, RAMP-HT participants also had a 42% lower risk of any CVD event (hazard ratio [HR]: 0.58; 95% confidence interval [CI]: 0.57–0.59); 38% lower risk of CVD (HR: 0.62; 95% CI: 0.61–0.64); 42% lower risk of end-stage kidney disease (HR: 0.54; 95% CI: 0.5–0.59); 17% lower risk of diabetes (HR: 0.83; 95% CI: 0.8–0.85); and 48% lower risk of all-cause mortality (HR: 0.52; 95% CI: 0.5–0.54), compared with usual care.
Yu and colleagues noted that risk reductions in mortality and CVD may be attributable to the combined effects of blood pressure and low-density lipoprotein cholesterol control. They concluded: “RAMP-HT participants had a higher likelihood or achieving blood pressure control and low density lipoprotein cholesterol control compared with usual care patients after 5 years, where a greater proportion of RAMP-HT participants were prescribed statins.” It was also noted that nurse-led risk assessments and interventions further helped to grow patient empowerment in self-care in areas such as smoking cessation, dietary modifications, and physical activity.
Limitations were acknowledged by Yu, who described that “the effect of implementing these strategies on the population level is unclear, and evidence for longer-term effects (> 24 months) on cardiovascular outcomes, mortality, or health service use remains sparse.” Future study should target these points.
