Hypertension Improvement Project(HIP)

高血压影响了25%的美国成年人口，并且仍然是心血管疾病的主要原因。 疾病只有25%的高血压患者达到目标血压（BP）.高血压的改善 项目（HIP）是一项随机对照试验，将测试单独和联合的BP控制效果， 针对医生的持续质量改进（CQI）干预和针对患者的行为干预。 医生将从杜克初级保健研究联盟的实践中挑选， 收入和少数民族。实践被随机分配到医生（MD）干预或MD 控制条件在这些实践中，所有MD都接受相同的干预，他们的患者单独 随机分配至患者干预或患者常规护理条件。MD干预包括三个方面 主要要素：在线培训模块;临床使用的评估和治疗算法; CQI 涉及评估临床绩效指标并向医生反馈其遵守 指南将收集18个月的性能数据，并每3个月向MD提供反馈 个月来自这些实践的患者（- 50%女性，至少40%非裔美国人，90%低收入）将 随机分配到患者干预或常规护理。患者干预包括6个月的行为干预， 干预旨在改变生活方式以降低血压，并坚持服用处方BP药物。BP和其他 在干预结束时和一年后进行跟踪测量（即，在术后6个月和18个月， 随机化）。 主要结果是每个治疗组中血压控制在6时的患者比例。 个月血压控制由JNC-6目标定义（大多数患者收缩压< 140，舒张压< 90 mmHg; 心血管或肾脏疾病或糖尿病患者的目标较低）。其他结果包括血压控制在18 月，医生遵守国家指南，患者遵守生活方式建议， 药物治疗。还将进行成本分析。该研究将在10个诊所招募400名患者 （约20名医生），并将有80%的把握度检测到主要结局的效应量为0.3。的 HIP研究将测试可广泛实施的改善高血压控制的实际干预措施， 降低CVD风险。

Hypertension affects 25 % of the adult US population overall and remains a leading cause of cardiovascular disease. Only 25 % of people with hypertension are at goal blood pressure (BP). The Hypertension Improvement Project (HIP) is a randomized, controlled trial that will test the separate and combined effects on BP control of a continuous quality improvement (CQI) intervention for physicians and a behavioral intervention for patients. Physicians will be selected from practices in the Duke Primary Care Research Consortium that serve low income and minority populations. Practices are randomly assigned to the physician (MD) intervention or to the MD control condition. Within these practices, all MDs receive the same intervention, and their patients are individually randomized to the patient intervention or to the patient usual care condition. The MD intervention consists of three main elements: on-line training modules; an evaluation and treatment algorithm for use in the clinic; and a CQI procedure involving assessment of Clinical Performance Measures and feedback to physicians on their adherence to guidelines. The performance data will be collected for 18 months and feedback will be provided to MDs every 3 months. Patients from these practices (- 50% women, at least 40% African American, 90% low income)will be randomly assigned to the patient intervention or usual care. The patient intervention consists of a 6-month behavioral intervention aimed at lifestyle changes to lower BP and adherence to prescribed BP medications. BP and other follow-up measurements are performed at the end of the intervention and a year later (i.e., at 6 and 18 months post- randomization). The primary outcome is the proportion of patients in each treatment group that have adequate BP control at 6 months. BP control is defined by JNC-6 goals (systolic BP < 140 and diastolic BP < 90 mmHg for most patients; lower goals for patients with cardiovascular or renal disease or diabetes). Other outcomes include BP control at 18 months, physician adherence to national guidelines, and patient adherence to lifestyle recommendations and medication regimens. A cost analysis will also be done. The study will enroll 400 patients in 10 practices (approximately 20 physicians), and will have 80% power to detect an effect size of 0.3 for the primary outcome. The HIP study will test practical interventions for improving hypertension control that can be broadly implemented and reduce CVD risk.