Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial
Background Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to us...
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| Veröffentlicht in: | Trials 2018, Vol.19 (1) |
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| creator | Jafar, Tazeen H Tan, Ngiap Chuan Allen, John C Finkelstein, Eric A Goh, Paul Moey, Peter Quah, Joanne Hui Min Hwang, Siew Wai Bahadin, Juliana Thiagarajah, Anandan Gerard Chan, Jason Kang, Gary Koong, Agnes |
| description | Background Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics. Methods/design The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care. The components of the MCI are: (1) an algorithm-driven antihypertensive treatment for all hypertensive individuals using single-pill combination (SPC) and lipid-lowering medication for high-risk hypertensive individuals, (2) a motivational conversation for high-risk hypertensive individuals, (3) telephone-based follow-ups of all hypertensive individuals by polyclinic nurses, and (4) discounts on SPC antihypertensive medications. The trial will be conducted with 1000 individuals aged [greater than or equai to] 40 years with uncontrolled hypertension (systolic BP [greater than or equai to] 140 mmHg or diastolic BP [greater than or equai to] 90 mmHg, based on the mean of the last two of three measurements) in eight polyclinics in Singapore. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability adjusted life years (DALY) averted and quality adjusted life years (QALY) saved will be computed. Discussion The demonstration of an effective and cost-effective hypertension control program that is implementable in busy polyclinics would provide compelling evidence for upscaling the program across all primary-care centers in Singapore, and possibly other regional countries with a similar health-care structure. Trial registration Clinicaltrials.gov, NCT02972619. Registered on 23 November 2016. Keywords: Hypertension, Blood pressure, cardiovascular, Single-pill combination, Motivational counseling, Telephone follow-up |
| doi_str_mv | 10.1186/s13063-018-2559-x |
| format | Report |
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The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics. Methods/design The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care. The components of the MCI are: (1) an algorithm-driven antihypertensive treatment for all hypertensive individuals using single-pill combination (SPC) and lipid-lowering medication for high-risk hypertensive individuals, (2) a motivational conversation for high-risk hypertensive individuals, (3) telephone-based follow-ups of all hypertensive individuals by polyclinic nurses, and (4) discounts on SPC antihypertensive medications. The trial will be conducted with 1000 individuals aged [greater than or equai to] 40 years with uncontrolled hypertension (systolic BP [greater than or equai to] 140 mmHg or diastolic BP [greater than or equai to] 90 mmHg, based on the mean of the last two of three measurements) in eight polyclinics in Singapore. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability adjusted life years (DALY) averted and quality adjusted life years (QALY) saved will be computed. Discussion The demonstration of an effective and cost-effective hypertension control program that is implementable in busy polyclinics would provide compelling evidence for upscaling the program across all primary-care centers in Singapore, and possibly other regional countries with a similar health-care structure. Trial registration Clinicaltrials.gov, NCT02972619. Registered on 23 November 2016. Keywords: Hypertension, Blood pressure, cardiovascular, Single-pill combination, Motivational counseling, Telephone follow-up</description><identifier>ISSN: 1745-6215</identifier><identifier>EISSN: 1745-6215</identifier><identifier>DOI: 10.1186/s13063-018-2559-x</identifier><language>eng</language><publisher>BioMed Central Ltd</publisher><subject>Analysis ; Antihypertensive agents ; Cardiovascular diseases ; Care and treatment ; Clinical trials ; Diagnosis ; Dosage and administration ; Drug therapy ; Health care costs ; Hypertension ; Patient outcomes ; Risk factors</subject><ispartof>Trials, 2018, Vol.19 (1)</ispartof><rights>COPYRIGHT 2018 BioMed Central Ltd.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>776,780,860,4476,27902</link.rule.ids></links><search><creatorcontrib>Jafar, Tazeen H</creatorcontrib><creatorcontrib>Tan, Ngiap Chuan</creatorcontrib><creatorcontrib>Allen, John C</creatorcontrib><creatorcontrib>Finkelstein, Eric A</creatorcontrib><creatorcontrib>Goh, Paul</creatorcontrib><creatorcontrib>Moey, Peter</creatorcontrib><creatorcontrib>Quah, Joanne Hui Min</creatorcontrib><creatorcontrib>Hwang, Siew Wai</creatorcontrib><creatorcontrib>Bahadin, Juliana</creatorcontrib><creatorcontrib>Thiagarajah, Anandan Gerard</creatorcontrib><creatorcontrib>Chan, Jason</creatorcontrib><creatorcontrib>Kang, Gary</creatorcontrib><creatorcontrib>Koong, Agnes</creatorcontrib><title>Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial</title><title>Trials</title><description>Background Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics. Methods/design The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care. The components of the MCI are: (1) an algorithm-driven antihypertensive treatment for all hypertensive individuals using single-pill combination (SPC) and lipid-lowering medication for high-risk hypertensive individuals, (2) a motivational conversation for high-risk hypertensive individuals, (3) telephone-based follow-ups of all hypertensive individuals by polyclinic nurses, and (4) discounts on SPC antihypertensive medications. The trial will be conducted with 1000 individuals aged [greater than or equai to] 40 years with uncontrolled hypertension (systolic BP [greater than or equai to] 140 mmHg or diastolic BP [greater than or equai to] 90 mmHg, based on the mean of the last two of three measurements) in eight polyclinics in Singapore. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability adjusted life years (DALY) averted and quality adjusted life years (QALY) saved will be computed. Discussion The demonstration of an effective and cost-effective hypertension control program that is implementable in busy polyclinics would provide compelling evidence for upscaling the program across all primary-care centers in Singapore, and possibly other regional countries with a similar health-care structure. Trial registration Clinicaltrials.gov, NCT02972619. Registered on 23 November 2016. Keywords: Hypertension, Blood pressure, cardiovascular, Single-pill combination, Motivational counseling, Telephone follow-up</description><subject>Analysis</subject><subject>Antihypertensive agents</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Diagnosis</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Health care costs</subject><subject>Hypertension</subject><subject>Patient outcomes</subject><subject>Risk factors</subject><issn>1745-6215</issn><issn>1745-6215</issn><fulltext>true</fulltext><rsrctype>report</rsrctype><creationdate>2018</creationdate><recordtype>report</recordtype><sourceid/><recordid>eNqVTctOwzAQtBBIlMcHcNsfSIkbO7TcEAL10hO9o5WzSRacdWQ7CPgL_piAOPSKRqOZWWlnlLrS5VLrdX2ddFXWVVHqdbGydlO8H6mFvjG2qFfaHh_4U3WW0ktZmmpTmYX62qFgRwNJhtBC_zFSzCSJgwBKA8PkM4-eIHJ6hRZdDjFBDkDSozgCh7Hh8IbJTR4j9IQ-98ACTywdjiHSLex7-o3bw3bnp5QpQpxnwsCf1ECOjP5CnbToE13-6blaPj7s77dFh56eWdqQI7oZDQ3sglDL8_3Omlqb6of_fvgGeqZniQ</recordid><startdate>20180314</startdate><enddate>20180314</enddate><creator>Jafar, Tazeen H</creator><creator>Tan, Ngiap Chuan</creator><creator>Allen, John C</creator><creator>Finkelstein, Eric A</creator><creator>Goh, Paul</creator><creator>Moey, Peter</creator><creator>Quah, Joanne Hui Min</creator><creator>Hwang, Siew Wai</creator><creator>Bahadin, Juliana</creator><creator>Thiagarajah, Anandan Gerard</creator><creator>Chan, Jason</creator><creator>Kang, Gary</creator><creator>Koong, Agnes</creator><general>BioMed Central Ltd</general><scope/></search><sort><creationdate>20180314</creationdate><title>Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial</title><author>Jafar, Tazeen H ; Tan, Ngiap Chuan ; Allen, John C ; Finkelstein, Eric A ; Goh, Paul ; Moey, Peter ; Quah, Joanne Hui Min ; Hwang, Siew Wai ; Bahadin, Juliana ; Thiagarajah, Anandan Gerard ; Chan, Jason ; Kang, Gary ; Koong, Agnes</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-gale_infotracacademiconefile_A5461436143</frbrgroupid><rsrctype>reports</rsrctype><prefilter>reports</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Analysis</topic><topic>Antihypertensive agents</topic><topic>Cardiovascular diseases</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Diagnosis</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Health care costs</topic><topic>Hypertension</topic><topic>Patient outcomes</topic><topic>Risk factors</topic><toplevel>online_resources</toplevel><creatorcontrib>Jafar, Tazeen H</creatorcontrib><creatorcontrib>Tan, Ngiap Chuan</creatorcontrib><creatorcontrib>Allen, John C</creatorcontrib><creatorcontrib>Finkelstein, Eric A</creatorcontrib><creatorcontrib>Goh, Paul</creatorcontrib><creatorcontrib>Moey, Peter</creatorcontrib><creatorcontrib>Quah, Joanne Hui Min</creatorcontrib><creatorcontrib>Hwang, Siew Wai</creatorcontrib><creatorcontrib>Bahadin, Juliana</creatorcontrib><creatorcontrib>Thiagarajah, Anandan Gerard</creatorcontrib><creatorcontrib>Chan, Jason</creatorcontrib><creatorcontrib>Kang, Gary</creatorcontrib><creatorcontrib>Koong, Agnes</creatorcontrib></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jafar, Tazeen H</au><au>Tan, Ngiap Chuan</au><au>Allen, John C</au><au>Finkelstein, Eric A</au><au>Goh, Paul</au><au>Moey, Peter</au><au>Quah, Joanne Hui Min</au><au>Hwang, Siew Wai</au><au>Bahadin, Juliana</au><au>Thiagarajah, Anandan Gerard</au><au>Chan, Jason</au><au>Kang, Gary</au><au>Koong, Agnes</au><format>book</format><genre>unknown</genre><ristype>RPRT</ristype><atitle>Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial</atitle><jtitle>Trials</jtitle><date>2018-03-14</date><risdate>2018</risdate><volume>19</volume><issue>1</issue><issn>1745-6215</issn><eissn>1745-6215</eissn><abstract>Background Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics. Methods/design The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care. The components of the MCI are: (1) an algorithm-driven antihypertensive treatment for all hypertensive individuals using single-pill combination (SPC) and lipid-lowering medication for high-risk hypertensive individuals, (2) a motivational conversation for high-risk hypertensive individuals, (3) telephone-based follow-ups of all hypertensive individuals by polyclinic nurses, and (4) discounts on SPC antihypertensive medications. The trial will be conducted with 1000 individuals aged [greater than or equai to] 40 years with uncontrolled hypertension (systolic BP [greater than or equai to] 140 mmHg or diastolic BP [greater than or equai to] 90 mmHg, based on the mean of the last two of three measurements) in eight polyclinics in Singapore. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability adjusted life years (DALY) averted and quality adjusted life years (QALY) saved will be computed. Discussion The demonstration of an effective and cost-effective hypertension control program that is implementable in busy polyclinics would provide compelling evidence for upscaling the program across all primary-care centers in Singapore, and possibly other regional countries with a similar health-care structure. Trial registration Clinicaltrials.gov, NCT02972619. Registered on 23 November 2016. Keywords: Hypertension, Blood pressure, cardiovascular, Single-pill combination, Motivational counseling, Telephone follow-up</abstract><pub>BioMed Central Ltd</pub><doi>10.1186/s13063-018-2559-x</doi></addata></record> |
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| source | DOAJ Directory of Open Access Journals; SpringerLink Journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Analysis Antihypertensive agents Cardiovascular diseases Care and treatment Clinical trials Diagnosis Dosage and administration Drug therapy Health care costs Hypertension Patient outcomes Risk factors |
| title | Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial |
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