Impact of a structured intensive follow-up program on the control of hypertension in coronary patients--a randomized trial.

Introduction: Hypertension is an important risk factor for cardiovascular events. Although several anti-hypertensive agents have shown to be effective in the treatment of hypertension, adequate blood pressure control is not frequent in most populations. The aim of this study was to evaluate the effect of a structured intensive follow-up program (SIFUP) on the control of blood pressure in coronary patients. Patients and Methods: we performed a prospective, randomized study including 237 patients admitted to the Cardiology Department for acute coronary syndrome. Patients were randomly assigned to a SIFUP (n=129) or to the general cardiology outpatient department (COD) (n=108). An experienced doctor performed a blind assessment of blood pressure in 157 randomised patients, 9 to 18 months after discharge. In statistical analysis, the chisquare test was used to compare proportions and the Student's t test to compare means. Results: Both groups were predominantly male and mean age was similar. The proportion of patients with known hypertension randomised to the SIFUP and the COD did not differ. At the 9 to 18-month assessment there was no statistical significant difference in the proportion of patients with blood pressure under target values (57.5% in SIFUP and 48.5% in COD, p=NS). However, in hypertensive patients, the proportion of controlled patients was significantly higher in the SIFUP than in the COD (44.8% vs. 24.2%, p=0.05) and systolic and mean blood pressure were significantly lower in the SIFUP (respectively 139.0 vs. 148.8 mmHg, p=0.04 and 98.7 vs. 103.9 mmHg, p=0.03); diastolic blood pressure was also lower in SIFUP (78.5 vs. 81.5 mmHg, p=NS). Conclusions: The SIFUP has shown to be effective in lowering blood pressure in hypertensive coronary patients. The proportion of patients with controlled blood pressure was consistently higher in the SIFUP.