Improvement of hypertension management by structured physician education and feedback system: cluster randomized trial

Eur J Cardiovasc Prev Rehabil. 2010 Jun;17(3):271-9. doi: 10.1097/HJR.0b013e328330be62.


Introduction: We aimed to assess whether hypertension management with a structured physician information program and a feedback system leads to improved blood pressure (BP) control and cardiovascular outcomes.

Methods: Cluster randomized (3 : 1), open, monitored, multicenter trial in Germany. Primary care-based physicians in the information group (IG) received detailed training on hypertension guidelines, feedback on target-level attainment, and a reminder to intensify treatment after each patient visit, whereas the observation/control group (CG) did not receive any such measures. A three-level mixed model was developed. Time-independent level differences between groups, group-independent changes, and nonparallel group-specific changes over time were tested.

Results: A total of 15 041 (78.1%) hypertensive patients were in the IG and 4213 (21.9%) in the CG. By 1-year follow-up, 82.9% of patients in the IG and 81.5% in the CG remained in the study. The guideline-oriented BP target was attained by 56.8% in the IG and 52.5% in the CG (+4.3%, P = 0.03), whereas the individual BP target was attained by 57.0% in the IG and 51% in the CG (P = NS). BP control in the IG was achieved 2 months earlier on average. Clinical inertia, defined as the absence of medication changes, despite noncontrol of BP, occurred significantly less often in the IG group. One-year cardiovascular outcomes did not differ between groups.

Conclusion: The delivery of systematic information in connection with a feedback system reduces clinical inertia and improves guideline adherence. Although compared with earlier studies, the hypertension control rates obtained are higher, there is still considerable room for improvement.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Attitude of Health Personnel
  • Blood Pressure / drug effects
  • Cluster Analysis
  • Education, Medical, Continuing*
  • Feedback, Psychological
  • Female
  • Germany / epidemiology
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Hypertension / therapy*
  • Male
  • Middle Aged
  • Physicians, Family / education*
  • Physicians, Family / psychology
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Prospective Studies
  • Reminder Systems*
  • Risk Reduction Behavior*
  • Time Factors
  • Treatment Outcome


  • Antihypertensive Agents