Evidence map›Paper›PMID 19237683›Full record

Trial reportHypertension (Dallas, Tex. : 1979)2009

A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial.

Ross D Feldman, Guang Y Zou, Margaret K Vandervoort, Cindy J Wong, Sigrid A E Nelson, Brian G Feagan

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Hypertension (Dallas, Tex. : 1979), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 92 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
92citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

92 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Guideline
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  5. Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2017
    Guideline
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32 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Ross D FeldmanRobarts Research Institute, 100 Perth Dr, London, Ontario N6A 5K8, Canada. Ross.Feldman@lhsc.on.ca
Guang Y Zou
Margaret K Vandervoort
Cindy J Wong
Sigrid A E Nelson
Brian G Feagan

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7% versus 52.7%; absolute difference: 12.0%; 95% CI: 1.5% to 22.4%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.

Indexed as

AlgorithmsFamily PracticeAdolescentAdultAgedAged, 80 and overAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersAntihypertensive AgentsBlood PressureDiureticsDrug Therapy, CombinationFemaleHumansHypertensionMaleAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersAntihypertensive AgentsDiuretics

Identifiers

PMID19237683

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.