title: Simplified therapeutic intervention to control hypertension and hypercholesterolemia: a cluster randomized controlled trial (STITCH2).
abstract: BACKGROUND
  Notwithstanding improving rates of hypertension control in North America, management of patients with both hypertension and dyslipidemia remains problematic. Based on evidence of improved control utilizing a simplified algorithm for management of hypertension (STITCH), we questioned whether a simplified comprehensive treatment algorithm featuring initial use of single-pill combinations (SPCs) would improve management of participants with both hypertension and dyslipidemia.
  
  
  METHODS
  We randomized 35 primary care practices in Ontario to either Guidelines-care (following current Canadian guidelines) or STITCH2-care (following a treatment algorithm featuring SPCs). Practices each enrolled up to 50 participants with at least one risk factor above target at entry based on Canadian guidelines for BP and LDL-cholesterol control. The primary endpoint was achieving targets for both hypertension and dyslipidemia control after 6 months, assessed at the practice level.
  
  
  RESULTS
  The primary endpoint was achieved in 31.3% of participants in STITCH2-care practices, compared with 28.1% in Guidelines-care practices, yielding a difference of 3.2% (P = 0.63). Notably, STITCH2-care practices had a significantly greater reduction in SBP while LDL-cholesterol reduction was only marginally greater in STITCH2 practices.
  
  
  CONCLUSIONS
  The STITCH2 algorithm resulted in significantly greater use of any SPC compared with Guidelines-care and greater use of the SPC of calcium channel blocker/statin. Unwillingness of the prescribing physician to advance treatment beyond a monotherapy threshold was found to be an important determinant for failing to achieve blood pressure control. In contrast, the more important determinant for failing to achieve LDL control appeared to be the unwillingness of the prescribing physician to initiate therapy with a statin.
authors.affiliation: Robarts Research Institute, PO Box 5015, 100 Perth Drive, London, ON N6A 5K8, Canada.
authors.forename: George K
authors.initials: GK
authors.lastname: Dresser
authors.forename: Sigrid A E
authors.initials: SA
authors.lastname: Nelson
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Mahon
authors.forename: Guangyong
authors.initials: G
authors.lastname: Zou
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Vandervoort
authors.forename: Cindy J
authors.initials: CJ
authors.lastname: Wong
authors.forename: Brian G
authors.initials: BG
authors.lastname: Feagan
authors.forename: Ross D
authors.initials: RD
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood; D016000:Cluster Analysis; D003971:Diastole / Q000187:drug effects; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D004338:Drug Combinations