SCOPING REVIEW OF BLOOD PRESURE OUTCOMES FOLLOWING ATTENDANCE AT SPECIALIST HYPERTENSION CLINICS
DESTINY O’DEA1, ANDREW CHUNG2, ARUNIMA JAIN1,2, AMY KANG1,3, ZOLTAN ENDRE1,2, SRADHA KOTWAL1,2,3
1Department of Nephrology, Prince Of Wales Hospital, Sydney, Australia, 2School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia, 3The George Institute for Global Health, Sydney, Australia
Aim: To perform a scoping review to determine whether attendance at specialist hypertension clinics improve blood pressure (BP) outcomes. Secondary objectives include analysis of patient characteristics and clinical outcomes.
Background: Hypertension is an important preventable risk factor for cardio-kidney disease, with limited data regarding the impact on BP control following management in specialist hypertension clinics.
Methods: Three databases (PUBMED, EMBASE, EBM) were searched for prospective and retrospective studies assessing BP outcomes in dedicated tertiary hypertension clinics led by physicians and/or nurse practitioners, published after 1982. Studies conducted in specialist clinics that were not hypertension-specific or without BP outcomes were excluded. Study and patient characteristics, and BP outcomes were summarised.
Results: Of the 1655 articles reviewed, 13 studies met inclusion criteria with four retrospective audits, four prospective case-control studies, two cohort studies and three randomised controlled trials. Common BP outcomes within the 13 studies included improved systolic or diastolic BP (8/13) or proportion of participants who achieved target BP as defined by the individual studies (8/13).
Most studies (10/13, 76.9%) included consecutively referred patients, while 3/13 (23%) reviewed patients referred for treatment-resistant hypertension. Study population ranged from 20 to 1000 participants, with median 122 participants (IQR 80-353). Follow-up duration was between three and 12 months (median 12, IQR 5.5-12) with 11/13 (85%) studies conducted in single centres.
Overall 8/13 studies (61.5%) reported improved BP outcomes, with 6/8 reporting improved systolic or diastolic BP and 2/8 suggesting majority (>50%) participants achieved target BP.
Conclusions: This review suggests that hypertension clinics may improve BP control, but highlights heterogeneity in inclusion criteria and reported BP outcomes. Further studies with standardised outcomes will help clarify efficacy of specialist hypertension clinics.
Biography:
Dr Arunima Jain is an early career Nephrologist, currently dual training in Obstetric Medicine at the Royal Hospital for Women in Sydney. She has been awarded a NHMRC Postgraduate Scholarship to pursue her PhD next year through the University of New South Wales, in collaboration with a multidisciplinary team. Her research will focus on improving diagnosis and management of kidney disease in and beyond pregnancy. Additional clinical and research areas of interest include hypertension and peritoneal dialysis.