title: Effects of a multifaceted educational program on blood pressure and cardiovascular risk in hypertensive patients: the Austrian herz.leben project.
abstract: OBJECTIVE
  Although hypertension is the most prevalent risk factor for cardiovascular and cerebrovascular morbidity and mortality, the level of blood pressure control remains poor. To amplify quality of care in hypertensive patients, a multifaceted program consisting of structured educational programs for both patients and staff, structured documentation and feedback reports with peer comparison, was implemented on a multicentre basis. Main targets were improvement of blood pressure control and reduction of cardiovascular risk. A provisional reimbursement was provided.
  
  
  METHODS
  Patients were eligible for inclusion in the program if office blood pressure was uncontrolled (>160/95 or >140/90 mmHg) in addition to elevated cardiovascular risk [>15% according to the New Zealand Risk Score (NZRS)]. Blood pressure and lipid panels were measured at entry in the program and after 12 months. Patients attended four educational units held by hypertension nurses and physicians. All data were collected in structured documentation sheets and benchmarking reports were provided every 6 months.
  
  
  RESULTS
  Two thousand and forty-one patients were enrolled in the program within 5 years and 3 months; 54% female, age 62.8 ± 11.1years, BMI 29.50 ± 7.88 kg/m (mean ± SD). To date, 744 patients have been seen at 1-year follow-up. Entry blood pressure was 156.1 ± 20.8/88.9 ± 11.1 mmHg. Total cholesterol showed mean levels of 207.0 ± 46.0 mg/dl, low-density lipoprotein 122.3 ± 41.6 mg/dl, high-density lipoprotein 57.2 ± 22.4 mg/dl and calculated cardiovascular risk level (NZRS) was 17.28 ± 8.29%. One year following the educational program, blood pressure was reduced to 139.2 ± 15.6 (P < 0.001)/82.1 ± 9.5 mmHg (P < 0.001). NZRS (14.1 ± 7.2%; P < 0.001) and BMI (29.26 ± 4.92 versus 29.06 ± 4.99) also improved significantly.
  
  
  CONCLUSIONS
  This structured educational program showed its ability to improve intermediate outcomes in hypertensive patients. Better blood pressure control and significant reduction of the individual cardiovascular risk profile were achieved. A broad implementation of the program in the management of hypertension seems justified.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. sabine.perl@medunigraz.at
authors.forename: Sabine
authors.initials: S
authors.lastname: Perl
authors.forename: Vesna
authors.initials: V
authors.lastname: Riegelnik
authors.forename: Peter
authors.initials: P
authors.lastname: Mrak
authors.forename: Herbert
authors.initials: H
authors.lastname: Ederer
authors.forename: Ivo
authors.initials: I
authors.lastname: Rakovac
authors.forename: Peter
authors.initials: P
authors.lastname: Beck
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kraler
authors.forename: Ingrid
authors.initials: I
authors.lastname: Stoff
authors.forename: Sigrid
authors.initials: S
authors.lastname: Winklehner
authors.forename: Gert
authors.initials: G
authors.lastname: Klima
authors.forename: Burkert M
authors.initials: BM
authors.lastname: Pieske
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pieber
authors.forename: Robert
authors.initials: R
authors.lastname: Zweiker
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001317:Austria; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents