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dc.contributor.authorStewart, Simonen
dc.contributor.authorStocks, Nigel Pen
dc.contributor.authorBurrell, Louise Men
dc.contributor.authorde Looze, Ferdinandus Jen
dc.contributor.authorEsterman, Adrianen
dc.contributor.authorHarris, Marken
dc.contributor.authorHung, Josephen
dc.contributor.authorSwemmer, Carla Hen
dc.contributor.authorKurstjens, Nicol Pen
dc.contributor.authorJennings, Garry Len
dc.contributor.authorCarrington, Melinda Jen
dc.identifier.citationJournal of Hypertension; 32(6): 1342-50en
dc.description.abstractTo examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics and 1562 randomized participants.Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1-5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up.Mean age was 59.3 ± 12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132 ± 14/79 ± 9 and 51% to 141 ± 15/83 ± 11  mmHg and 19% in those participants subject to the highest (n = 270, 26%) versus least (n = 148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15-1.31; for achieving BP target (P < 0.001). Participants with a per protocol score of 4 or 5 (512/1038, 49.3%) were 1.54-fold (95% CI 1.31-1.81; P < 0.001) more likely to achieve their individual BP target compared with usual care. Clinics equipped with a practice nurse significantly influenced protocol adherence (adjusted RR 1.20, 95% CI 1.06-1.37; P = 0.004) and individual BP control (RR 1.21, 95% CI 1.04-1.41; P = 0.015).There is considerable potential for structured care management to improve BP control in primary care, especially when optimally applied.en
dc.subject.otherAntihypertensive Agents.therapeutic useen
dc.subject.otherBlood Pressure.drug effectsen
dc.subject.otherBlood Pressure Determinationen
dc.subject.otherHypertension.drug therapyen
dc.subject.otherMiddle Ageden
dc.subject.otherPatient Complianceen
dc.subject.otherPrimary Health Care.organization & administrationen
dc.subject.otherProspective Studiesen
dc.subject.otherTetrazoles.therapeutic useen
dc.subject.otherTime Factorsen
dc.subject.otherTreatment Outcomeen
dc.subject.otherValine.analogs & derivatives.therapeutic useen
dc.titleMore rigorous protocol adherence to intensive structured management improves blood pressure control in primary care: results from the Valsartan Intensified Primary carE Reduction of Blood Pressure study.en
dc.typeJournal Articleen
dc.identifier.journaltitleJournal of Hypertensionen
dc.identifier.affiliationaNHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Preventive Health, Baker IDI Heart and Diabetes Institute, Melbourne bDiscipline of General Practice, University of Adelaide, Adelaide cDepartments of Medicine and Cardiology, The University of Melbourne, Austin Health, Melbourne dSchool of Medicine, University of Queensland, Brisbane eUniversity of South Australia, Adelaide fCentre for Primary Healthcare and Equity, University of New South Wales, Sydney gSchool of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth hNovartis Pharmaceuticals Australia Ltd., Sydney, Australiaen
dc.contributor.corpauthorVIPER-BP Study Investigatorsen
dc.type.austinJournal Articleen, Louise M
item.fulltextNo Fulltext-
item.openairetypeJournal Article- Medicine- (University of Melbourne)-
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