title: Hypertension Management in Primary Care.
abstract: BACKGROUND
  To improve hypertension control, this cluster randomized trial evaluated the effectiveness of physician manager education about hypertension management.
  
  
  METHODS
  After randomization at practice level, primary care physicians of the intervention arm, whose practices collaborated with a university department, participated in a three-session education on evidence-based hypertensiology and practice implementation strategies. The primary outcome was blood pressure (BP) control (ambulatory blood pressure [ABP] <130/80 mmHg) after 5 months. Secondary outcomes were changes in BP and practice routines regarding hypertension management. Following an intention-to-treat approach, data analyses included crude and adjusted generalized mixed models and sensitivity analyses. These took into account sex, age, ≥ hypertension-related disease and resistant hypertension (RH).
  
  
  RESULTS
  The analysis included 103 of 169 patients from 22 practices. Overall, BP decrease was -8.2 systolic and -4.1 mmHg diastolic. The intervention had no effect on BP control (odds ratio 0.84 [95% CI 0.29-2.43]) and BP changes (interventional effect: systolic -2.48 mmHg [95% CI -7.24 to 2.29], diastolic -0.25 mmHg [95% CI 3.31 to 2.82]). Sensitivity analysis indicated effect modification in patients with RH. Intervention practices requested educational input on difficult cases, and newly implemented 3 practice strategies (14.5±2.6 versus 11.4±2.2; P=0.005).
  
  
  CONCLUSIONS
  After the short follow-up of 5 months, the intervention had no impact on BP control but improved the use of practice strategies.
authors.affiliation: Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Weltermann
authors.forename: Christine
authors.initials: C
authors.lastname: Kersting
authors.forename: Anja
authors.initials: A
authors.lastname: Viehmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods / Q000458:organization & administration*; D004521:Educational Measurement; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult