Clinical Outcomes of integrated primary care models in Patients with essential hypertension

Kirsten Nilsson; M. Nilsson; I. Karlsson

doi:10.5281/zenodo.22813559

Authors

Kirsten Nilsson Department of Clinical Primary Care Research, Parana Center for General and Internal Medicine Author https://orcid.org/8927-4157-9015-8209
M. Nilsson Department of General and Internal Medicine, Yamuna Research Center for Primary Care Research Author https://orcid.org/3365-8969-4222-9573
I. Karlsson Department of Clinical Primary Care Research, Yamuna Research Center for Primary Care Research Author https://orcid.org/5117-2474-4579-757X

DOI:

https://doi.org/10.5281/zenodo.22813559

Keywords:

essential hypertension, integrated primary care, blood pressure control, chronic care model, telemonitoring

Abstract

Graphical abstract

Background: Blood pressure control rates remain well below guideline targets in most primary care settings despite effective antihypertensive therapy, and team-based, protocol-driven models of care have consistently outperformed usual physician-only follow-up in prior trials [10,11].

Objective: This study reports twelve-month clinical outcomes for patients with essential hypertension managed under an integrated primary care model combining nurse-led protocol visits, home blood pressure telemonitoring and pharmacist-supported titration, benchmarked against usual primary care.

Methods: We conducted a prospective, controlled cohort study of 612 adults with essential hypertension across participating general and internal medicine clinics, comparing 308 patients managed under the integrated model with 304 receiving usual care, with blood pressure control at twelve months as the primary outcome.

Results: Blood pressure control was achieved in 71.4% of the integrated care cohort versus 46.7% of the usual-care cohort (p<0.001), with a mean additional systolic reduction of 8.8 mmHg and a lower composite rate of cardiovascular and renal events, 4.2% versus 8.6% (p=0.03).

Conclusions: An integrated primary care model combining structured nurse visits, home telemonitoring and pharmacist-directed titration produced substantially better blood pressure control and fewer adverse cardiovascular and renal outcomes than usual care, supporting broader adoption of such models in essential hypertension management [13,3].

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