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Cluster-randomized controlled trial for the early promotion of clinic visits for untreated hypertension

Hypertension Research volume 44, pages 355–362 (2021)Cite this article

Abstract

Despite clear evidence of the benefits of lowering blood pressure among patients with hypertension, the treatment rate remains <40% worldwide. In the present trial, we aimed to investigate the effects of the early promotion of clinic visits among patients with untreated hypertension detected during annual health checkups. This was a worksite-based, parallel group, cluster-randomized trial with blinded outcome assessment. Employees of 152 Japanese supermarket stores found to have untreated hypertension (blood pressure levels ≥ 160/100 mmHg) during health checkups were assigned to an early promotion group (encouraged to visit a clinic in face-to-face interviews and provided with a referral letter to a physician as well as a leaflet) or a control group (received usual care), according to random assignment. The primary outcome was the completion of a clinic visit within 6 months. Odds ratios with 95% confidence intervals for the early promotion group versus the control group were estimated using multilevel logistic regression with random effects of clusters. A total of 273 participants (mean age 50.3 years, 55% women) from 107 stores were assigned to the early promotion group (138 from 55 stores) or control group (135 from 52 stores). During the 6-month follow-up, 47 (34.1%) participants in the early promotion group visited a clinic, as did 26 (19.3%) in the control group (odds ratio 2.33, 95% confidence interval 1.12–4.84, P = 0.024). Early promotion using a referral letter during health checkups significantly increased the number of clinic visits within 6 months completed by participants with untreated hypertension (UMIN000025411).

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Acknowledgements

The authors are deeply indebted to Dr. Shoji Tabata, the staff of Ishikawa-ken Health Service Association, and the staff of Foundation of General Incorporated Foundation Kinki Health Administration Center for their excellent support. We also thank all members of Heiwado Health Insurance Society and Heiwado Occupational Health Care Office, especially Ms. Atsuko Kawamura for her careful coordination of the staff administering the health checkups. We thank Analisa Avila, ELS, of Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this paper.

Funding

This study was partly supported by a Grant-in-Aid for Scientific Research (Grant number 17K17539) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Authors and Affiliations

  1. Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan

    Azusa Shima, Yukako Tatsumi, Ayumi Morino, Kayo Godai, Saori Azuma & Naomi Miyamatsu

  2. Occupational Health Care Office, Heiwado Co., Ltd, Shiga, Japan

    Azusa Shima, Yuichiro Kawatsu & Ayumi Morino

  3. Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan

    Hisatomi Arima

  4. Department of Public Health, Shiga University of Medical Science, Shiga, Japan

    Katsuyuki Miura

  5. Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan

    Yukako Tatsumi & Takayoshi Ohkubo

  6. General Incorporated Foundation Kinki Health Administration Center, Shiga, Japan

    Takashi Kimura

  7. Division of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan

    Kayo Godai

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  1. Azusa Shima
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Correspondence to Azusa Shima.

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Three authors (AS, AM, and YK) are salaried employees of the retail company where the present study was conducted. The other authors declare no conflicts of interest.

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Shima, A., Arima, H., Miura, K. et al. Cluster-randomized controlled trial for the early promotion of clinic visits for untreated hypertension. Hypertens Res 44, 355–362 (2021). https://doi.org/10.1038/s41440-020-00559-0

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