Background: Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets.
Methods: A pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients' clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life.
Results: 1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups.
Conclusion: An easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets.
Trial Registration: This trial was registered with ClinicalTrials.gov, number NCT00348855.
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http://dx.doi.org/10.1186/1745-6215-14-318 | DOI Listing |
Lancet Reg Health West Pac
January 2025
Division of Nephrology, National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Background: Early diagnosis of chronic kidney disease (CKD) is crucial for timely intervention to delay disease progression and improve patient outcomes. However, data for clinical characteristics of Chinese patients with undiagnosed, early-stage CKD are lacking.
Methods: REVEAL-CKD is a multinational, observational study using real-world data in selected countries to describe factors associated with undiagnosed stage 3 CKD, time to diagnosis, and CKD management post diagnosis.
Front Med (Lausanne)
January 2025
National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China.
Aims: To compare the efficiency of scleral buckling (SB) and pars plana vitrectomy (PPV) with or without SB in patients with primary simple phakic fovea-splitting rhegmatogenous retinal detachment (RRD).
Methods: A retrospective case-control study included 101 patients aged <55 years diagnosed with phakic fovea-splitting RRD. The primary outcome was functional success, defined as achieving a postoperative logarithm of the minimum angle of resolution best-corrected visual acuity of 0.
Front Immunol
January 2025
Laboratory of Immunohematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
Obesity is a rapidly growing health problem worldwide, affecting both adults and children and increasing the risk of chronic diseases such as type 2 diabetes, hypertension and cardiovascular disease (CVD). In addition, obesity is closely linked to chronic kidney disease (CKD) by either exacerbating diabetic complications or directly causing kidney damage. Obesity-related CKD is characterized by proteinuria, lipid accumulation, fibrosis and glomerulosclerosis, which can gradually impair kidney function.
View Article and Find Full Text PDFPak J Med Sci
January 2025
Dr. Ayesha Babar Kawish, MSPH Al-Shifa School of Public Health, Al-Shifa Trust, Rawalpindi, Pakistan.
Background & Objectives: Poor medication adherence is an essential contributor to Pakistan's high prevalence of uncontrolled hypertension. This study will be aimed to assess the efficacy of a one-of-a-kind developed intervention in improving medication adherence and treatment outcomes in hypertension patients.
Methods: Twleve months duration long randomized controlled trial from January to December 2021 will be carried out at Shaikh Zayed Medical Complex (SZMC), Lahore.
Pak J Med Sci
January 2025
Syed Khurram Shehzad, Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan.
Objectives: To determine the frequency of undiagnosed hypertension among the diabetic patients with micro vascular complications.
Method: This is a descriptive case series conducted at Department of Medicine, Ghurki Trust Teaching Hospital, in this six month stud which enrolled 213 patients between 18-60 years from March 28, 2021 to September 28, 2021, having diabetes with microvascular complications. These patients were not previously diagnosed as hypertensives.
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