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Cluster-Randomized Controlled Trial of Oscillometric vs. Manual Sphygmomanometer for Blood Pressure Management in Primary Care (CRAB)

Citation

Nelson, MR and Quinn, S and Bowers-Ingram, L and Nelson, JM and Winzenberg, TM, Cluster-Randomized Controlled Trial of Oscillometric vs. Manual Sphygmomanometer for Blood Pressure Management in Primary Care (CRAB) , American Journal of Hypertension, 22, (6) pp. 598-603. ISSN 0895-7061 (2009) [Refereed Article]

DOI: doi:10.1038/ajh.2009.55

Abstract

Background Although mercury sphygmomanometers are seen as the gold standard instrument for blood pressure (BP) measurement, they are being withdrawn due to safety concerns. CRAB was a clusterrandomized controlled trial in 24 family practices in Tasmania, Australia, which aimed to determine the effect of an oscillometric device on BP management. Methods Cluster-randomized controlled trial. Intervention practices were supplied with automated monitors and control (usual care) practices used mercury or aneroid sphygmomanometers. They were subsequently audited by a research nurse. Usual care practice audit periods were matched to intervention practices. All analyses were intention-to-treat and adjusted for potential clustering. Differences in BP were analyzed using generalized estimating equations. All other outcomes were analyzed using multilevel mixed-effects Poisson regression. Post hoc analyses were performed to determine the mediators of changes in prescribing behavior. Results A total of 3,355 records were reviewed (828 visits had BP recordings). The percentage of BP recordings ending in "0" was significantly lower in intervention vs. usual care practices (systolic BP (SBP) 18% (107/587) vs. 71% (233/329), diastolic BP (DBP) 20% (119/584) vs. 70% (229/328), P < 0.001). The mean of SBP recordings in the intervention group was 7.5 mm Hg (95% confidence interval (CI) 5.2, 9.9 mm Hg, P < 0.001) higher than in the usual care group. Patients taking BP lowering drugs were more likely (incidence rate ratio (IRR) 1.3, 95% CI 1.1, 1.7, P = 0.01) to have a BP lowering drug prescribed if they were in the intervention compared to the usual care. Conclusions Although digit preference was largely eliminated by oscillometric measurement, prescribing behavior was mediated by SBP.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Primary Health Care
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Nelson, MR (Professor Mark Nelson)
Author:Quinn, S (Dr Stephen Quinn)
Author:Bowers-Ingram, L (Ms Lin Bowers-Ingram)
Author:Nelson, JM (Ms Jan Nelson)
Author:Winzenberg, TM (Professor Tania Winzenberg)
ID Code:59749
Year Published:2009
Web of Science® Times Cited:20
Deposited By:Menzies Institute for Medical Research
Deposited On:2009-12-16
Last Modified:2011-07-28
Downloads:0

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