Skip to content

Research at St Andrews

Improving management of hypertension in general practice: A randomised controlled trial of feedback derived from electronic patient data

Research output: Contribution to journalArticle


Elizabeth Mitchell, Frank Sullivan, Jeremy M. Grimshaw, Peter T. Donnan, Graham Watt

School/Research organisations


Background. Although absolute risk of death associated with raised blood pressure increases with age, the benefits of treatment are greater in older patients. However, fewer patients in this group are identified, treated, and controlled. Aim. To evaluate the impact of the provision of different levels of feedback on identification, treatment, and control of older patients with hypertension. Design of study. Randomised controlled trial. Setting. Fifty-two Scottish general practices. Method. Practices were randomly allocated to either control (n = 19), audit only feedback (n = 16), or audit plus risk feedback, prioritising patients by absolute risk (n = 17). Electronic data were extracted from practice computer systems annually from 1999 to 2001 and used to develop feedback. Data were collected for 30 345 patients aged 65-79 years. Results. The majority of known patients with hypertension in each group had an initial blood pressure recorded (control = 89.6%; audit = 80.4%; risk = 96.1%) and this increased over the study period (control = 92.3%; audit = 86.0%; risk = 96.6%). Initially, more than 80% of patients in each group were treated but many were uncontrolled (blood pressure ≥160/≥90mmHg) (control = 41.5%; audit = 41.3%; risk = 36.1%). The numbers of untreated and uncontrolled patients in each group reduced (control = 32.3%; audit = 38.3%; risk = 32.6%). There was some evidence of a significant difference in mean systolic pressure between the audit plus risk and audit only groups: (149.6 versus 152.7 mmHg; P = 0.019) and of significantly greater control in the audit plus risk group compared with the other groups 49.4% (versus audit only = 35.4%; versus control = 46.5%; odds ratio = 1.72 [95% confidence interval = 1.09 to 2.70]; P = 0.019). Conclusions. Levels of identification, treatment, and control improved in each group. Although there were still significant numbers of patients with uncontrolled hypertension, there is some evidence to suggest that providing patient-specific feedback may have a positive impact on identification and management of hypertension in older people and produce an increase in control.



Original languageEnglish
Pages (from-to)94-101
Number of pages8
JournalBritish Journal of General Practice
Issue number511
Publication statusPublished - 1 Feb 2005

    Research areas

  • Decision making, Hypertension, Information storage and retrieval, Medical records

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study

    O’Neill, B., Kalia, S., Aliarzadeh, B., Sullivan, F., Moineddin, R., Kelly, M. & Greiver, M., 16 Oct 2020, In : BMJ Open. 10, 10, 9 p., e038013.

    Research output: Contribution to journalArticle

  2. Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging

    Sullivan, F. M., Mair, F. S., Anderson, W., Armory, P., Briggs, A., Chew, C., Dorward, A., Haughney, J., Hogarth, F., Kendrick, D., Littleford, R., Mcconnachie, A., McCowan, C., Mcmeekin, N., Patel, M., Rauchhaus, P., Ritchie, L., Robertson, C., Robertson, J., Robles-Zurita, J. & 8 others, Sarvesvaran, J., Sewell, H., Sproule, M., Taylor, T., Tello, A., Treweek, S., Vedhara, K. & Schembri, S., 30 Jul 2020, In : European Respiratory Journal. Early View, 2000670.

    Research output: Contribution to journalArticle

Related by journal

  1. Finding and using routine clinical datasets for observational research and quality improvement

    McDonnell, L. M., Delaney, B., Sullivan, F. & Cheesbrough, G. F., Mar 2018, In : British Journal of General Practice. 68, 668, p. 147-148

    Research output: Contribution to journalArticle

  2. Atomic data: James Mackenzie lecture 2015

    Sullivan, F., May 2016, In : British Journal of General Practice. 66, 646, p. e368-70

    Research output: Contribution to journalComment/debate

  3. The GP as an investigator

    Madhok, V. B., Al-Shahi Salman, R. & Sullivan, F., Aug 2014, In : British Journal of General Practice. 64, 625, p. 409

    Research output: Contribution to journalArticle

  4. Lessons from Mackenzie that still resonate

    Van Hecke, O., Smith, B. H. & Sullivan, F. M., 1 Jan 2013, In : British Journal of General Practice. 63, 608, p. 158-159 2 p.

    Research output: Contribution to journalArticle

  5. Trimethoprim prescription and subsequent resistance in childhood urinary infection: Multilevel modelling analysis

    Duffy, A. M., Hernandez-Santiago, V., Orange, G., Davey, P. G. & Guthrie, B., Apr 2013, In : British Journal of General Practice. 63, 609

    Research output: Contribution to journalArticle

ID: 267719186