HypertensionRandomised controlled trial
Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial
- Cluster randomised controlled trial
- pragmatic
- open label
- 94 primary care practices
Authors' conclusion
Use of a CDSS in primary care in China improved the provision of guideline accordant antihypertensive treatment and led to a modest reduction in blood pressure.
Study context
- Population
- Patients with hypertension on up to two classes of antihypertensives with SBP <180 mm Hg and DBP <110 mm Hg, primary care practices in four urban regions of China, 2019–202294 practices (46 vs 48)
- Participants
- 12,137 patients
- Comparison
- EHR-based clinical decision support system (CDSS) vs usual care
- CDSSn = 5,755
- Usual caren = 6,382reference
- Primary endpoint
- Proportion of hypertension related visits with appropriate (guideline accordant) treatment
Primary result
As reported in the abstract
Visits with appropriate (guideline accordant) treatment · median 11.6 months of follow-up
Absolute difference, percentage points (95% CI)P value
Intervention vs Control
15.2(10.7–19.8)
P < 0.001Odds ratio (95% CI)P value
Intervention vs Control
2.17(1.75–2.69)
P < 0.001Secondary outcomes
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| Reduction in SBP · last scheduled follow-up | Intervention −1.5 mm Hg · Control 0.3 mm Hg | greater reduction 1.6 mm Hg (95% CI −2.7 to −0.5) | P = 0.006 |
| BP control (<140/90 mm Hg) · last scheduled follow-up | Intervention 69.0% · Control 64.6% | improvement 4.4 percentage point (95% CI −0.7 to 9.5) | P = 0.07 |
Safety
Patient reported antihypertensive treatment related adverse effects
- Rare in both groups
Original publication
Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial. BMJ. Published 23 July 2024. doi:10.1136/bmj-2023-079143
Summarised from the published abstract; every number is checked against it