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Randomized Controlled Trial
. 2009 Jan;24(1):33-9.
doi: 10.1007/s11606-008-0825-4. Epub 2008 Oct 21.

Discussing coronary risk with patients to improve blood pressure treatment: secondary results from the CHECK-UP study

Steven A Grover  1 , Ilka Lowensteyn, Lawrence Joseph, Mohammed Kaouache, Sylvie Marchand, Louis Coupal, Ghislain Boudreau
Affiliations
Randomized Controlled Trial

Discussing coronary risk with patients to improve blood pressure treatment: secondary results from the CHECK-UP study

Steven A Grover et al. J Gen Intern Med. 2009 Jan.

Abstract

Objectives: Hypertension is common among patients with dyslipidemia but is often poorly treated. The objective of this analysis was to evaluate how a decision aid, used by primary care physicians to improve lipid therapy, impacted on the treatment of hypertension.

Study design: Data were analyzed from patients enrolled in a randomized trial focusing primarily on the treatment of dyslipidemia. Patients received usual care or a coronary risk profile every three months to monitor the risk reduction following lifestyle changes and/or pharmacotherapy to treat dyslipidemia. Hypertension management was assessed based on a post hoc analysis of individuals whose blood pressure exceeded current national hypertension guidelines.

Results: There were 2,631 subjects who completed the study. Among 1,352 patients without diagnosed hypertension, 30% were above target on at least three consecutive visits. Among 1,279 individuals with known hypertension, 69% were above target on at least two consecutive visits. Overall, patients receiving risk profiles were more likely to receive appropriate antihypertensive therapy (OR = 1.40, 95% CI 1.11-1.78) compared to those receiving usual care. After adjustment for inter-physician variability and potential confounders, the use of the risk profile was associated with an increased likelihood of starting therapy (OR = 1.78, 95% CI 1.06-3.00) or modifying therapy (OR = 1.40, 95% CI 1.03-1.91).

Conclusions: In this clinical trial of dyslipidemia management, inadequately controlled hypertension was common, occurring in nearly 50% of individuals. Ongoing coronary risk assessment was associated with more appropriate blood pressure management. Cardiovascular risk assessment decision aids should be further evaluated in a randomized trial of hypertension therapy.

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