Effect of cardiovascular risk-based approach in primary care physician-led management for 19,400 hypertensive patients in southern china

<b>Background and objectives</b> Hypertension is a leading cause of cardiovascular morbidity and mortality among Chinese adults who accounts for one fifth of world population. Primary care physicians are given more responsibility to provide longitudinal care for hypertensive patients. This study aimed to examine the effect of the intervention by primary care physicians using cardiovascular risk-based approach for Chinese hypertensive patients.<p></p> <b>Methods</b> DESIGN A longitudinal, pre-post study from 2007 until 2011. Multistage cluster sampling methodology was adopted in identifying study sites. PARTICIPANTS 19,400 hypertensive patients and 196 primary care physicians. INTERVENTIONS Education on cardiovascular risk reduction with follow-up by primary care physicians. The intensity of medication treatment was determined by the stratification of risk for cardiovascular diseases (CVDs). OUTCOMES the difference in change in blood pressure and lipid profiles.<p></p> <b>Results</b> The mean (SD) age of patients was 52.5 (5.7) years with a male proportion of 54.0%. The baseline mean (SD) systolic/diastolic BP was 146.1 (19.4)/84.6 (11.3) mm Hg. CVD-related health indicators significantly improved after a five-year follow-up period. Mean systolic BP decreased from 146.1 to 135.1 mm Hg (p&lt;0.001); mean diastolic BP declined from 84.6 to 79.6 mm Hg (p&lt;0.001); mean triglyceride level dropped from 31.7 to 30.1 mg/dl (p = 0.035); mean total cholesterol fell from 96.4 to 74.8 mg/dl (p = 0.042); and mean HDL cholesterol increased from 28.1 to 46.3 mg/dl (p = 0.044).<p></p> <b>Conclusions</b> This study demonstrated that primary care physician-led management with cardiovascular risk-based approach achieved significant and sustainable improvements on the cardiovascular indicators among Chinese populations in the long term