Effectiveness of the Risk Assessment and Management Programme for hypertension (RAMP-HT) in reducing complications and service utilization: A population-based matched prospective cohort study

BackgroundThe Risk Assessment and Management Programme for Hypertension (RAMP-HT) is a multi-component team-based intervention implemented in public primary care clinics across Hong Kong since 2011. After 12 months, significantly greater proportion of RAMP-HT participants achieved target blood pressure (Odd Ratio (OR) 1.18, P<0.001) and low-density lipoprotein-Cholesterol levels (OR 1.13, P<0.001) compared to usual care patients. This study evaluated the effectiveness of RAMP-HT for reducing hypertension-related complications and health service utilization among patients with hypertension relative to usual care after 5 years. Methods and FindingsO_ST_ABSDesignC_ST_ABSPopulation-based prospective matched cohort study SettingAll 73 public primary care clinics in Hong Kong Participants212,707 adults with uncomplicated hypertension managed in public primary care clinics in Hong Kong between 2011 and 2013 were included. 108,045 RAMP-HT participants were matched to 104,662 patients receiving usual care using propensity score fine stratification weightings. Main outcome measuresHypertension-related complications (cardiovascular diseases (CVD), end-stage renal disease (ESRD)), all-cause mortality, public health service utilization (overnight hospitalization, attendances at accident and emergency department (AED), specialist outpatient clinic (SOPC) and general outpatient clinic (GOPC). ResultsAfter a median follow-up of 5.4 years, RAMP-HT participants had 8.0%, 1.6% and 10.0% lower absolute risks for CVD events, ESRD and all-cause mortality, respectively, compared to patients receiving usual care. After adjusting for all baseline covariates, the RAMP-HT group was associated with a 38% (Hazard Ratio (HR) 0.62, (95% CI 0.61 to 0.64)), 46% (HR 0.54, (95% CI 0.50 to 0.59)), and 48% (HR 0.52, (95% CI 0.50 to 0.54)) lower risk of CVD, ESRD, and all-cause mortality respectively, compared to the usual care group. The number-needed-to-treat was 16 to prevent one CVD event, 106 for ESRD and 17 for all-cause mortality. RAMP-HT participants also had significantly lower incidences for overnight hospitalization, AED, and SOPC attendances (Incidence Rate Ratio (IRR) 0.60, 0.70 and 0.87, respectively) but more GOPC attendances (IRR 1.06) compared to usual care patients. ConclusionsRAMP-HT was associated with significant and clinically important reductions in all-cause mortality and hypertension-related complications for patients with hypertension in the naturalistic primary care setting after 5 years. Trial registrationNCT02219958