Question

What interventions can improve control of blood pressure in patients with hypertension?

Bottom Line

An organised system of registration, recall and regular review allied to a vigorous stepped care approach to antihypertensive treatment reduced blood pressure and all-cause mortality in a single, large randomised controlled trial. Health professional (nurse or pharmacist) led care appears to be a promising way of delivering care but requires further evaluation.

Caveat

Trials of educational interventions directed at patients or health professionals were heterogeneous and appear unlikely to be associated with large net reductions in blood pressure by themselves.

Context

Hypertension is a common problem in general practice. International community based studies show that blood pressure goals are achieved in only 25-40 per cent of patients who take antihypertensives.1 There is a paucity of evidence as to how care for hypertensive patients should be delivered in the community to help improve blood pressure control.