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Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study

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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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Acknowledgements

The study was funded by Pfizer Canada. The study design was conceived by the principal investigator and the protocol was reviewed and modified by an independent steering committee (see appendices). The sponsor participated in discussions regarding study design and protocol development and provided logistical support during the trial. The investigators were responsible for data collection, data analysis, and preparation of the manuscript independently of the funding source. The sponsor was permitted to review the manuscript but all final decisions regarding content remained the responsibility of the principal investigator.

Conflict of Interests

Dr. Steven Grover, Dr. Ilka Lowensteyn, Mr. Mohammed Kaouache, Mr. Louis Coupal, and Ms. Sylvie Marchand have received research grants from Pfizer, Sanofii Aventis, and AstraZeneca. Dr. Grover has received speaker honoraria from Pfizer, Sanofi Aventis, and Orynx. As well, Dr. Grover has either been a consultant or participated on an advisory board for AstraZeneca, Sanofi Aventis, Pfizer and Merck. Dr. Ghislain Boudreau has ownership interests and is a full-time employee within the medical division of Pfizer Canada Inc. Dr. Lawrence Joseph has no conflict of interest.

The risk profiles in the manuscript are used by Clinemetrica Inc. for screening events and the McGill Cardiovascular Health Improvement Program for patient care.

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Corresponding author

Correspondence to Steven A. Grover MD, MPA, FRCPC.

Additional information

The study was funded by Pfizer Canada. The study design was conceived by the principal investigator and the protocol was reviewed and modified by an independent steering committee (see appendices). The sponsor participated in discussions regarding study design and protocol development and provided logistical support during the trial. The investigators were responsible for data collection, data analysis, and preparation of the manuscript independently of the funding source. The sponsor was permitted to review the manuscript, but all final decisions regarding content remained the responsibility of the principal investigator. Dr. Grover, Dr. Lowensteyn, Mr. Kaouache, Mr. Coupal, and Ms. Marchand have received research grants from Pfizer, Sanofii Aventis, and AstraZeneca. Dr. Grover has received speaker honoraria from Pfizer, Sanofi Aventis, and Orynx. In addition, Dr. Grover has either been a consultant or participated on an advisory board for AstraZeneca, Sanofi Aventis, Pfizer and Merck.

Appendices

Appendix 1

Table 4 shows the participants in the CHECK-UP study group.

Table 4 The CHECK-UP Study Group

Appendix 2

Table 5 shows the members of the scientific advisory board.

Table 5 Scientific Advisory Board

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Grover, S.A., Lowensteyn, I., Joseph, L. et al. Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study. J GEN INTERN MED 24, 33–39 (2009). https://doi.org/10.1007/s11606-008-0825-4

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  • DOI: https://doi.org/10.1007/s11606-008-0825-4

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