Clinical benefits of the Multi-disciplinary Risk Assessment and Management Programme-Hypertension (RAMP-HT) for patients with Hypertension in GOPCs - the First Year Experience

Abstract

Introduction: Since October 2011, the Hospital Authority (HA) has introduced the Risk Assessment and Management Programme (RAMP) for patients with hypertension (HT) managed in the public primary care setting. The programme aimed to improve cardiovascular outcomes for hypertensive patients through risk assessment, risk stratification and risk-guided management by a multi-disciplinary effort. This study evaluated the clinical benefits of RAMP-HT at 12-month. Method: Evaluation involved 5 clusters under HA that had launched RAMP-HT since Oct 2011. A sampling of 13,155 hypertensive patients aged ≤80, without existing cardiovascular diseases and with suboptimal blood pressure (i.e. systolic blood pressure (SBP) >140mmHg or diastolic blood pressure (DBP) >90mmHg) who were enrolled into RAMP-HT for more than one year was compared to 33,172 non-RAMP-HT participants on clinical outcomes including SBP, low-density lipoprotein cholesterol (LDL-C) and the estimated 10-year cardiovascular disease (CVD) risk using Framingham risk scores equation to reveal the net benefit of RAMP-HT. Multivariate linear regressions were used to identify the net effectiveness of RAMP-HT by adjusting the potential confounding variables. Results: There was a reduction in mean SBP, LDL-C and estimated 10-year cardiovascular risk in both the RAMP-HT participants and hypertensive patients receiving usual care from general-out-patient-clinics (GOPCs) at 12 months. The RAMP-HT participants had greater reduction in LDL-C (coef. = -0.02, P-value = 0.04) and estimated 10-years CVD risk (coef. = -0.45, P-value < 0.01) compared to the usual care group, and the difference was statistically significant. RAMP-HT participants also had a greater reduction in SBP than the usual care group, however the difference did not reach statistical significance. Discussion: For hypertensive patients aged ≤80 with suboptimal blood pressure control but without existing cardiovascular complications, the multi-disciplinary RAMP-HT was shown to confer additional clinical benefits over usual care at GOPCs in terms of a greater reduction of estimated 10-year CVD risk and LDL-C at 12 months. A more comprehensive and longer-term evaluation of the effectiveness of RAMP-HT should be performed to better illustrate the true clinical impact of such programme.