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Objective: The International Society of Hypertension (ISH) recommended lower blood pressure (BP) targets in hypertension management using an individualized treatment strategy (ITS) and referral to a hypertension specialist if target is not reached within 6 months. This study was designed to test the hypothesis that in general practice the ITS may fail to achieve target BP within 6 months in a high proportion of patients, whereas a stepwise treatment strategy (STS) (as in the outcome studies, e.g. the HOT study) may be superior. Methods: GPs were trained in the ISH guidelines and were randomized to achieve in their patients the new BP targets within 6 months using ITS or a fosinopril based STS. Untreated or treated uncontrolled hypertensives were included (validated automated oscillometric devices, device-printed measurements). Results: 21 GPs were randomized (STS/ITS 11/10 GPs, 231/211 patients). There were no differences between groups in age (65 9 years), treatment status (70% treated) and target BP (51% with target 130/85 mm Hg). Baseline BP was higher in the STS (166.7/90.7 mm Hg; difference 4.7/2.3 mm Hg, p 0.05). At 6 months the decline in BP was similar in the two groups (30/11 and 28/10 mmHg, for STS and ITS respectively, p 0.0001 for all) whereas there were no differences in BP neither in the proportion of subjects who achieved target BP (54%/48% for STS/ITS). More drugs were administered in the STS group (combined therapy in 68%/59% for STS/ITS, p 0.06). Conclusions: In general practice both the ITS and the STS fail to achieve the new BP targets within 6 months in about 50% of patients.

Aggressive blood pressure control in general practice (ABC-GP) study: stepwise versus individualized treatment strategy