Clinical Question: Can patients with hypertension be seen every six months without loss of control, changes in patient satisfaction, or declines in adherence to treatment?
Setting: Outpatient (primary care)
Study Design: Randomized controlled trial (nonblinded)
Synopsis: Canadian, British, and U.S. guidelines regarding the management of hypertension suggest an interval of three to six months for follow-up in patients with controlled hypertension. This study explored the difference between three- and six-month follow-up in 609 patients with hypertension that had been controlled for at least three months by at least one drug. Patients were randomized (allocation assignment concealed) to return every three or six months, with earlier follow-up if blood pressure was out of control or if drug therapy was changed. Analysis was by intention to treat.
As expected, patients in the six-month group had significantly fewer office visits during the three years of the study (average: 16.2 versus 18.8 office visits in the three-month group), although they still were seen much more frequently than scheduled (i.e., they should have been seen an average of six and 12 times). Blood pressure measurements taken at the end of each year in the office were similar between the two groups. Blood pressure measurements taken at home were similar to the physicians’ measurements. At each period, approximately 20 percent of patients in each group were deemed by their physician to have out-of-control blood pressure. Satisfaction with care and self-reported adherence to therapy were similar in both groups. The study had the ability to find a true difference in blood pressure of less than 10 percent at a power of 0.8.
Bottom Line: Seeing patients with controlled hypertension every six months, rather than every three months, resulted in similar blood pressure measurements in the office and at home, with no changes in patient satisfaction or adherence to therapy. (Other patient-oriented evidence) (Level of Evidence: 1b)