Effects of community-based general practitioners-led care for 12,864 patients with hypertension: study of cardiovascular risk intervention - hypertension (SCRI-HTN) in China

Wang, H.H.X. and Wang, J.J. (2012) Effects of community-based general practitioners-led care for 12,864 patients with hypertension: study of cardiovascular risk intervention - hypertension (SCRI-HTN) in China. European Heart Journal, 33(Sup 1), pp. 762-763. (doi: 10.1093/eurheartj/ehs283)

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Publisher's URL: http://dx.doi.org/10.1093/eurheartj/ehs283

Abstract

<b>Background and objectives</b> Hypertension is emerging as a leading cause of cardiovascular morbidity, mortality, and disability among adults. General practitioners (GPs) working in the community health service (CHS) organizations are being positioned in the healthcare system to provide longitudinal care for hypertensive patients. This study aimed to determine the efficacy of a community-based intervention led by GPs on control of cardiovascular risk factors among patients with hypertension in China.<p></p> <b>Methods</b> DESIGN A longitudinal, pre-post study. SETTING 98 community health centres (CHCs) in Guangzhou, the most urbanized city in southern China. Multistage cluster sampling method was adopted in identifying the study sites. The study was carried out over a 5-year period from 2007 through 2011. PARTICIPANTS 12,864 adult patients who had diagnosed hypertension; and 196 certificate-trained general practitioners. INTERVENTIONS Cardiovascular risk reduction education; regular, long-term follow-up by general practitioners using scheduled consultations and counselling. The intensity of medication treatment was determined by the stratification of risk for cardiovascular disease (CVD). OUTCOME MEASURES The difference in change in systolic BP, diastolic BP, triglyceride, total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol.<p></p> <b>Results</b> Sufficient data were available for 12,864 patients. The mean (SD) patient age was 52.5 (7.5) years, 53.9% were male, and the mean (SD) systolic/diastolic BP was 146.1 (19.4)/84.6 (11.3) mm Hg at baseline. Several main indicators of cardiovascular health improved over the study period: mean systolic BP decreased from 146.1 to 135.1 mm Hg (p<0.001); mean diastolic BP declined from 84.6 to 79.6 mm Hg (p<0.001); mean triglyceride level dropped from 31.7 to 30.1 mg/dl (p=0.035); mean total cholesterol fell from 96.4 to 74.8 mg/dl (p=0.042); mean LDL cholesterol changed from 40.5 to 22.3 mg/dl (p=0.025); and mean HDL cholesterol increased from 28.1 to 46.3 mg/dl (p=0.044).<p></p> <b>Conclusions</b> This SCRI-HTN study showed that adult patients with hypertension receiving GPs-led care in the community health centres achieved statistically and clinically significant and sustained improvements on the cardiovascular indicators for as long as 5 years. It demonstrated that the participation of GPs as the core in the multi-disciplinary team to provide hypertension management care at the community level was both effective and feasible in meeting the health care needs of hypertensive population and also improving control of cardiovascular risk factors.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wang, Professor Haoxiang
Authors: Wang, H.H.X., and Wang, J.J.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Journal Name:European Heart Journal
Journal Abbr.:Eur. heart j.
ISSN:0195-668X
ISSN (Online):1522-9645

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