title: Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study.
abstract: This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention.
  
  
  
  A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables.
  
  
  
  Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk ≤20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = -0.44, P < 0.01).
  
  
  
  The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.
authors.affiliation: aDepartment of Family Medicine and Primary Care, The University of Hong Kong bPrimary and Community Services Department, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, Hong Kong.
authors.forename: Esther Y T
authors.initials: EY
authors.lastname: Yu
authors.forename: Eric Y F
authors.initials: EY
authors.lastname: Wan
authors.forename: Carlos K H
authors.initials: CK
authors.lastname: Wong
authors.forename: Anca K C
authors.initials: AK
authors.lastname: Chan
authors.forename: Karina H Y
authors.initials: KH
authors.lastname: Chan
authors.forename: Sin-Yi
authors.initials: SY
authors.lastname: Ho
authors.forename: Ruby L P
authors.initials: RL
authors.lastname: Kwok
authors.forename: Cindy L K
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006723:Hong Kong; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D008078:Cholesterol, LDL