General practice -based health checks are associated with statistically significant , albeit clinical ly small , improvements in surrogate outcome control , especially among high-risk patients .
BACKGROUND A recent review concluded that general health checks fail to reduce mortality in adults .
AIM This review focuses on general practice -based health checks and their effects on both surrogate and final outcomes .
Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial
Objective To determine the effectiveness of intensive structured care to optimise blood pressure control based on individual absolute risk targets in primary care . Design Pragmatic multicentre r and omised controlled trial . Setting General practice s throughout Australia , except Northern Territory , 2009 - 11 . Participants Of 2185 patients from 119 general practice s who were eligible for drug treatment for hypertension according to national guidelines 416 ( 19.0 % ) achieved their individual blood pressure target during a 28 day run-in period of monotherapy . After exclusions , 1562 participants not at target blood pressure ( systolic 150 ( SD 17 ) mm Hg , diastolic 88 ( SD 11 ) mm Hg ) were r and omised ( 1:2 ratio ) to usual care ( n=524 ) or the intervention ( n=1038 ) . Intervention Computer assisted clinical profiling and risk target setting ( all participants ) with intensified follow-up and stepwise drug titration ( initial angiotensin receptor blocker monotherapy or two forms of combination therapy using angiotensin receptor blockers ) for those r and omised to the intervention . The control group received usual care . Main outcome measures The primary outcome was individual blood pressure target achieved at 26 weeks . Secondary outcomes were change in mean sitting systolic and diastolic blood pressure , absolute risk for cardiovascular disease within five years based on the Framingham risk score , and proportion and rate of adverse events . Results On an intention to treat basis , there was an 8.8 % absolute difference in individual blood pressure target achieved at 26 weeks in favour of the intervention group compared with usual care group ( 358/988 ( 36.2 % ) v 138/504 ( 27.4 % ) ) : adjusted relative risk 1.28 ( 95 % confidence interval 1.10 to 1.49 , P=0.0013 ) . There was also a 9.5 % absolute difference in favour of the intervention group for achieving the classic blood pressure target of ≤140/90 mm Hg ( 627/988 ( 63.5 % ) v 272/504 ( 54.0 % ) ) : adjusted relative risk 1.18 ( 1.07 to 1.29 , P<0.001 ) . The intervention group achieved a mean adjusted reduction in systolic blood pressure of 13.2 mm Hg ( 95 % confidence interval −12.3 to −14.2 mm Hg ) and diastolic blood pressure of 7.7 mm Hg ( −7.1 to −8.3 mm Hg ) v 10.1 mm Hg ( −8.8 to 11.3 mm Hg ) and 5.5 mm Hg ( −4.7 to −6.2 mm Hg ) in the usual care group ( P<0.001 ) . Among 1141 participants in whom five year absolute cardiovascular risk scores  were calculated from baseline to the 26 week follow-up , the reduction in risk scores was greater in the intervention group than usual care group ( 14.7 % ( SD 9.3 % ) to 10.9 % ( SD 8.0 % ) ; difference −3.7 % ( SD 4.5 % ) and 15.0 % ( SD 10.1 % ) to 12.4 % ( SD 9.4 % ) ; −2.6 % ( SD 4.5 % ) : adjusted mean difference −1.13 % ( 95 % confidence interval −0.69 % to −1.63 % ; P<0.001 ) . Owing to adverse events 82 ( 7.9 % ) participants in the intervention group and 10 ( 1.9 % ) in the usual care group had their drug treatment modified . Conclusions In a primary care setting intensive structured care result ed in higher levels of blood pressure control , with clinical ly lower blood pressure and absolute risk of future cardiovascular events overall and with more people achieving their target blood pressure . An important gap in treatment remains though and applying intensive management and achieving currently advocated risk based blood pressure targets is challenging
General practice -based health checks are associated with statistically significant , albeit clinical ly small , improvements in surrogate outcome control , especially among high-risk patients .
BACKGROUND A recent review concluded that general health checks fail to reduce mortality in adults .
AIM This review focuses on general practice -based health checks and their effects on both surrogate and final outcomes .