European journal of preventive cardiology · 2026
Evaluation of hypertension-related complications 10 years after implementation of risk assessment and management programme for hypertension: a target trial emulation.
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Wong Zoey Cho Ting, Mak Ivy Lynn, Yu Esther Yee Tak, Tse Emily Tsui Yee, Chen Julie Yun, Chin Weng Yee, Chao David Vai Kiong, Tsui Wendy Wing Sze, Ha Tony King Hang, Wan Eric Yuk Fai, Lam Cindy Lo Kuen
Аннотация
AIMS: The risk assessment and management programme for hypertension (RAMP-HT) is a protocol-driven, risk-stratified, and multidisciplinary programme supplementing usual care for patients with hypertension (HT) in primary care. This study aimed to assess the association between RAMP-HT with complications and all-cause mortality compared with usual care only over 10 years.
METHODS AND RESULTS: In this prospective target trial emulation, electronic health records in Hong Kong were extracted, and sequence trials were emulated for patients with HT from January 2012 to December 2018. One-to-one propensity score matching was performed. Stabilized inverse probability treatment weights and pooled logistic regression were applied to obtain the hazard ratio for cardiovascular diseases (CVDs) and all-cause mortality between groups. A total of 337 990 eligible person-trials (168 995 per group) were included after propensity score matching. The incidence rate (IR) (cases/1000 person-years) of RAMP-HT was lower than the usual care group for CVD {RAMP-HT: IR 16.54 [95% confidence interval (CI) 16.31, 16.78]; usual care: IR 18.40 (95% CI 18.10, 18.69)} and all-cause mortality [RAMP-HT: IR 9.41 (95% CI 9.24, 9.59); usual care: IR 12.23 (95% CI 12.00, 12.47)]. Risk assessment and management programme for hypertension participants had significantly reduced risk of CVD [hazard ratio (HR): 0.91, 95% CI: 0.89, 0.93] and all-cause mortality (HR: 0.88, 95% CI: 0.86, 0.90) when compared with usual care patients.
CONCLUSION: Risk assessment and management programme for hypertension supplementing usual care associated with reduced relative risk of CVD and all-cause mortality risks in patients with HT by 9 and 12%, respectively, compared with patients receiving usual care only, supporting the integration of RAMP-HT with usual primary care in managing HT.
METHODS AND RESULTS: In this prospective target trial emulation, electronic health records in Hong Kong were extracted, and sequence trials were emulated for patients with HT from January 2012 to December 2018. One-to-one propensity score matching was performed. Stabilized inverse probability treatment weights and pooled logistic regression were applied to obtain the hazard ratio for cardiovascular diseases (CVDs) and all-cause mortality between groups. A total of 337 990 eligible person-trials (168 995 per group) were included after propensity score matching. The incidence rate (IR) (cases/1000 person-years) of RAMP-HT was lower than the usual care group for CVD {RAMP-HT: IR 16.54 [95% confidence interval (CI) 16.31, 16.78]; usual care: IR 18.40 (95% CI 18.10, 18.69)} and all-cause mortality [RAMP-HT: IR 9.41 (95% CI 9.24, 9.59); usual care: IR 12.23 (95% CI 12.00, 12.47)]. Risk assessment and management programme for hypertension participants had significantly reduced risk of CVD [hazard ratio (HR): 0.91, 95% CI: 0.89, 0.93] and all-cause mortality (HR: 0.88, 95% CI: 0.86, 0.90) when compared with usual care patients.
CONCLUSION: Risk assessment and management programme for hypertension supplementing usual care associated with reduced relative risk of CVD and all-cause mortality risks in patients with HT by 9 and 12%, respectively, compared with patients receiving usual care only, supporting the integration of RAMP-HT with usual primary care in managing HT.