Educore Project: Effect of a Visual Learning Method for Improving Blood Pressure Control (EDUCORE)

• Main outcome variable: control of blood pressure [ Time Frame: Baseline and 1 year ] [ Designated as safety issue: No ]
  Blood pressure (bp): systolic and diastolic blood pressure, determined using the Riva-Rocci method and listening for Korotkoff sounds, using validated and calibrated sphygmomanometers. Control BP: SBP < 140 mmHg and DBP < 90 mmHg
  
  

• Cardiovascular risk (CVR) level : Use of low risk SCORE table [ Time Frame: Baseline and 1 year ] [ Designated as safety issue: No ]

  Calculation of CVR at appointments 1, 3 and 5 (at the beginning of the experimental period and again at 6 and 12 months).

  Calculation of the projected CVR at 60 years of age for all patients under this age.

  
  
• Measure of Adherence to treatment (Morisky-Green questionnaire) [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  
• Smoking habits [ Time Frame: Baseline and 1 year ] [ Designated as safety issue: No ]
  
• Total Cholesterol [ Time Frame: Baseline and 1 year ] [ Designated as safety issue: No ]
  

Aim: To measure the effectiveness of an educational intervention in uncontrolled hypertensive patients without cardiovascular disease (primary prevention), compared with clinical practice to improve hypertension control in a year.

Method: This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics (PHCC), to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n=368 in the EDUCORE and control groups), all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg). All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded.

Information source: Clinical interview and assessments tests. The data will be registered in Electronic data capture system.

Statistical Analysis: Primary and secondary effectiveness. Adjusting by prognosis factors with random effects models (logistic regression) (dependent variable: good/bad blood pressure control; independent variable: intervention group).

Discussion: The EDUCORE method could provide a simple, inexpensive means of improving blood pressure control, and perhaps other health problems, in the primary healthcare setting.