Monday, November 05, 2007
Robarts Research Institute
Changing the way doctors treat high blood pressure
LONDON, ON (Nov 5, 2007) - Scientists at Robarts
Research Institute have developed a simplified
and more effective method of treating high blood
pressure.
The study, led by clinical pharmacologist Dr. Ross
Feldman and supported by Robarts Clinical Trials,
showed that more patients lowered their blood
pressure - and to a greater extent - when their
family doctors used a simplified, step-care
treatment protocol rather than having to choose
from the large number of drugs currently available
to treat high blood pressure.
The Simplified Treatment Intervention to Control
Hypertension (STITCH) trial was a study of 2,104
patients with high blood pressure (hypertension) at
45 family practices in southwestern Ontario,
Canada. In order to increase the number of
people with hypertension who reduce their blood
pressure to “goal” levels, researchers wanted to see
if there was a simpler way to direct treatment for
hypertension than by following national
guidelines for optimal management of blood
pressure.
“The complexity of existing guidelines for the
management of hypertension could be a barrier to
effective therapy,” said Ross D Feldman, M.D.,
R.W. Gunton Professor of Therapeutics, University
of Western Ontario, London, Canada. “To
examine this question, we conducted a cluster
randomization trial. Family practices were
randomly assigned to implement a simplified step-
care algorithm (STITCH-care) or Guidelines-based
care for the management of hypertension.”
The STITCH algorithm consisted of four steps: 1)
initiate therapy with ACE-inhibitor/diuretic or
Angiotensin receptor blocker/diuretic combination;
2) up-titrate combination therapy to the highest
dose; 3) add a calcium channel blocker and up-
titrate; 4) add one of the non-first line
antihypertensive agents. In the Guidelines-care
arm physicians were educated on the use of
existing national guidelines of the Canadian
Hypertension Education Program, including 12
options for initial therapy depending on the type
of hypertension and co-existing medical
conditions.
The proportion of patients who reduced blood
pressure to the target level was higher in the
STITCH-care group (65 percent) compared with
the Guidelines-care group (53 percent). Average
systolic blood-pressure (the top number in a blood
pressure measurement) was reduced by 23 mmHg
in the STITCH-care arm compared to a lesser
reduction of 18 mmHg in the Guidelines-care arm.
In addition, diastolic blood pressure (the bottom
number) was reduced by 10 mmHg in the STITCH-
care patients versus 8 mmHg in the Guidelines-
care group.
“Assignment to the STITCH-care arm increased
the chance of reaching the optimal blood pressure
target by over 20 percent,” said Dr. Feldman. “We
believe that use of a simplified algorithm for the
treatment of hypertension is implementable and
accepted by family physicians, and results in
improved blood pressure control rates. This return
to ‘step-care’ may be an important way forward for
the treatment of hypertension and may represent a
paradigm for the management of a range of
chronic diseases.”
Dr. Feldman presented his study results at the
American Heart Association conference Sunday,
November 4.
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