{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:08:55Z","timestamp":1786975735608,"version":"build-2736575974"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n There is a lack of information regarding the impact of implementing a protocol-driven, team-based, multicomponent intervention in public primary care settings on hypertension-related complications and health care burden over the long term.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare hypertension-related complications and health service use at 5 years among patients managed with Risk Assessment and Management Program for Hypertension (RAMP-HT) vs usual care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this population-based prospective matched cohort study, patients were followed up until the date of all-cause mortality, an outcome event, or last follow-up appointment before October 2017, whichever occurred first. Participants included 212\u202f707 adults with uncomplicated hypertension managed at 73 public general outpatient clinics in Hong Kong between 2011 and 2013. RAMP-HT participants were matched to patients receiving usual care using propensity score fine stratification weightings. Statistical analysis was conducted from January 2019 to March 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Nurse-led risk assessment linked to electronic action reminder system, nurse intervention, and specialist consultation (as necessary), in addition to usual care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Hypertension-related complications (cardiovascular diseases, end-stage kidney disease), all-cause mortality, public health service use (overnight hospitalization, attendances at accident and emergency department, specialist outpatient clinic, and general outpatient clinic).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 108\u202f045 RAMP-HT participants (mean [SD] age: 66.3 [12.3] years; 62\u202f277 [57.6%] female) and 104\u202f662 patients receiving usual care (mean [SD] age 66.3 [13.5] years; 60\u202f497 [57.8%] female) were included. After a median (IQR) follow-up of 5.4 (4.5-5.8) years, RAMP-HT participants had 8.0% absolute risk reduction in cardiovascular diseases, 1.6% absolute risk reduction in end-stage kidney disease, and 10.0% absolute risk reduction in all-cause mortality. After adjusting for baseline covariates, the RAMP-HT group was associated with lower risk of cardiovascular diseases (hazard ratio [HR], 0.62; 95% CI, 0.61-0.64), end-stage kidney disease (HR, 0.54; 95% CI, 0.50-0.59), and all-cause mortality (HR, 0.52; 95% CI, 0.50-0.54) compared with the usual care group. The number needed to treat to prevent 1 cardiovascular disease event, end-stage kidney disease, and all-cause mortality was 16, 106, and 17, respectively. RAMP-HT participants had lower hospital-based health service use (incidence rate ratios ranging from 0.60 to 0.87) but more general outpatient clinic attendances (IRR, 1.06; 95% CI, 1.06-1.06) compared with usual care patients.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this prospective matched cohort study involving 212\u202f707 primary care patients with hypertension, participation in RAMP-HT was associated with statistically significant reductions in all-cause mortality, hypertension-related complications, and hospital-based health service use after 5 years.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.15064","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T11:34:02Z","timestamp":1684928042000},"page":"e2315064","source":"Crossref","is-referenced-by-count":13,"title":["Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention"],"prefix":"10.1001","volume":"6","author":[{"given":"Esther Y. T.","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"},{"name":"Department of Family Medicine and Primary Care, The University of Hong Kong\u2013ShenZhen Hospital, Shen Zen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Y. F.","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"},{"name":"Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"},{"name":"Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivy L.","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David V. K.","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kowloon East Cluster, Hong Kong Hospital Authority, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Welchie W. K.","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Hong Kong West Cluster, Hong Kong Hospital Authority, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, New Territories East Cluster, Hong Kong Hospital Authority, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yim Chu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kowloon Central Cluster, Hong Kong Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, New Territories West Cluster, Hong Kong Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan","family":"Luk","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kowloon West Cluster, Hong Kong Hospital Authority, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle M. Y.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Hong Kong East Cluster, Hong Kong Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony K. H.","family":"Ha","sequence":"additional","affiliation":[{"name":"Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca K. C.","family":"Chan","sequence":"additional","affiliation":[{"name":"New Territories East Cluster Statistics Office, Prince of Wales Hospital, Hong Kong Hospital Authority, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Y. T.","family":"Fong","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy L. K.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"},{"name":"Department of Family Medicine and Primary Care, The University of Hong Kong\u2013ShenZhen Hospital, Shen Zen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"issue":"9859","key":"zoi230463r1","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","article-title":"A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.","volume":"380","author":"Lim","year":"2012","journal-title":"Lancet"},{"issue":"6","key":"zoi230463r2","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1161\/CIRCULATIONAHA.115.018912","article-title":"Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries.","volume":"134","author":"Mills","year":"2016","journal-title":"Circulation"},{"issue":"7","key":"zoi230463r3","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1097\/01.mlr.0000220260.30768.32","article-title":"Quality improvement strategies for hypertension management: a systematic review.","volume":"44","author":"Walsh","year":"2006","journal-title":"Med Care"},{"issue":"581","key":"zoi230463r4","doi-asserted-by":"publisher","first-page":"e476","DOI":"10.3399\/bjgp10X544113","article-title":"Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review.","volume":"60","author":"Glynn","year":"2010","journal-title":"Br J Gen Pract"},{"issue":"9970","key":"zoi230463r5","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1016\/S0140-6736(14)62256-X","article-title":"A public health approach to global management of hypertension.","volume":"385","author":"Angell","year":"2015","journal-title":"Lancet"},{"issue":"2","key":"zoi230463r6","doi-asserted-by":"publisher","first-page":"110","DOI":"10.7326\/M17-1805","article-title":"Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis.","volume":"168","author":"Mills","year":"2018","journal-title":"Ann Intern Med"},{"issue":"6","key":"zoi230463r7","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1108\/02689239810243904","article-title":"Seamless health care for chronic diseases in a dual health care system: managed care and the role of family physicians.","volume":"12","author":"Lee","year":"1998","journal-title":"J Manag Med"},{"issue":"2016\/4","key":"zoi230463r8","doi-asserted-by":"publisher","first-page":"51","DOI":"10.4000\/chinaperspectives","article-title":"Healthcare service in Hong Kong and its challenges. the role of health professionals within a social model of health.","author":"Schoeb","year":"2016","journal-title":"China Perspectives"},{"issue":"12","key":"zoi230463r9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0144492","article-title":"The association of types of training and practice settings with doctors\u2019 empathy and patient enablement among patients with chronic illness in Hong Kong.","volume":"10","author":"Yu","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"zoi230463r11","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s12875-015-0291-0","article-title":"Evaluation of the quality of care of a multi-disciplinary Risk Factor Assessment and Management Programme for Hypertension (RAMP-HT).","volume":"16","author":"Yu","year":"2015","journal-title":"BMC Fam Pract"},{"issue":"3","key":"zoi230463r12","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1097\/HJH.0000000000001177","article-title":"Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study.","volume":"35","author":"Yu","year":"2017","journal-title":"J Hypertens"},{"key":"zoi230463r13","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1136\/hrt.2005.079988","article-title":"JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice.","volume":"91","author":"British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association","year":"2005","journal-title":"Heart"},{"issue":"10","key":"zoi230463r15","doi-asserted-by":"publisher","first-page":"2937","DOI":"10.1681\/ASN.2006040368","article-title":"Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease.","volume":"17","author":"Ma","year":"2006","journal-title":"J Am Soc Nephrol"},{"issue":"10","key":"zoi230463r16","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.jclinepi.2006.01.009","article-title":"Using the outcome for imputation of missing predictor values was preferred.","volume":"59","author":"Moons","year":"2006","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"zoi230463r18","doi-asserted-by":"publisher","first-page":"499","DOI":"10.3102\/1076998609359785","article-title":"Marginal mean weighting through stratification: adjustment for selection bias in multilevel data.","volume":"35","author":"Hong","year":"2010","journal-title":"J Educ Behav Stat"},{"issue":"6","key":"zoi230463r19","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1111\/jep.12254","article-title":"Combining propensity score-based stratification and weighting to improve causal inference in the evaluation of health care interventions.","volume":"20","author":"Linden","year":"2014","journal-title":"J Eval Clin Pract"},{"issue":"1","key":"zoi230463r21","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1002\/bimj.v51:1","article-title":"Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations.","volume":"51","author":"Austin","year":"2009","journal-title":"Biom J"},{"issue":"7223","key":"zoi230463r22","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1136\/bmj.319.7223.1492","article-title":"Calculating the number needed to treat for trials where the outcome is time to an event.","volume":"319","author":"Altman","year":"1999","journal-title":"BMJ"},{"issue":"2","key":"zoi230463r23","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1093\/biomet\/75.2.383","article-title":"A stagewise rejective multiple test procedure based on a modified Bonferroni test.","volume":"75","author":"Hommel","year":"1988","journal-title":"Biometrika"},{"issue":"8","key":"zoi230463r24","doi-asserted-by":"publisher","first-page":"2250","DOI":"10.2337\/diacare.26.8.2250","article-title":"Specialist nurse-led intervention to treat and control hypertension and hyperlipidemia in diabetes (SPLINT): a randomized controlled trial.","volume":"26","author":"New","year":"2003","journal-title":"Diabetes Care"},{"issue":"10153","key":"zoi230463r25","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/S0140-6736(18)31776-8","article-title":"Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial.","volume":"392","author":"Gupta","year":"2018","journal-title":"Lancet"},{"issue":"7160","key":"zoi230463r26","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1136\/bmj.317.7160.703","article-title":"Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.","volume":"317","author":"Group","year":"1998","journal-title":"BMJ"},{"issue":"23","key":"zoi230463r27","doi-asserted-by":"publisher","first-page":"2998","DOI":"10.1001\/jama.288.23.2998","article-title":"Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).","volume":"288","author":"ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial","year":"2002","journal-title":"JAMA"},{"issue":"21","key":"zoi230463r28","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1056\/NEJMoa1600177","article-title":"Blood-Pressure and Cholesterol Lowering in Persons without Cardiovascular Disease.","volume":"374","author":"Yusuf","year":"2016","journal-title":"N Engl J Med"},{"issue":"9364","key":"zoi230463r29","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1016\/S0140-6736(03)12948-0","article-title":"Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.","volume":"361","author":"Sever","year":"2003","journal-title":"Lancet"},{"issue":"9602","key":"zoi230463r30","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1016\/S0140-6736(07)61778-4","article-title":"Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths.","volume":"370","author":"Lewington","year":"2007","journal-title":"Lancet"},{"issue":"9","key":"zoi230463r31","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1111\/jch.v22.9","article-title":"A cluster-randomized study on the Risk Assessment and Management Program for home blood pressure monitoring in an older population with inadequate health literacy.","volume":"22","author":"Fu","year":"2020","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"6","key":"zoi230463r32","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1056\/NEJMoa0706245","article-title":"Effect of a multifactorial intervention on mortality in type 2 diabetes.","volume":"358","author":"Gaede","year":"2008","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi230463r33","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/EDE.0000000000000627","article-title":"Matching weights to simultaneously compare three treatment groups: comparison to three-way matching.","volume":"28","author":"Yoshida","year":"2017","journal-title":"Epidemiology"},{"key":"zoi230463r34","doi-asserted-by":"publisher","first-page":"l5657","DOI":"10.1136\/bmj.l5657","article-title":"Alternative approaches for confounding adjustment in observational studies using weighting based on the propensity score: a primer for practitioners.","volume":"367","author":"Desai","year":"2019","journal-title":"BMJ"},{"key":"zoi230463r35","first-page":"129","article-title":"Accuracy and completeness of ICPC coding for chronic disease in general outpatient clinics.","volume":"32","author":"Wong","year":"2010","journal-title":"HK Pract"},{"key":"zoi230463r10","volume-title":"Hong Kong Primary Care Morbidity Survey 2007-2008","author":"Lo","year":"2010"},{"key":"zoi230463r14","author":"Department of Health HK SAR"},{"key":"zoi230463r17","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin","year":"2004"},{"key":"zoi230463r20","volume-title":"MMWS: Stata Module to Perform Marginal Mean Weighting Through Stratification","author":"Linden","year":"2014"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2805274\/yu_2023_oi_230463_1684177422.56134.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T11:34:10Z","timestamp":1684928050000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2805274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,24]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.15064","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,24]]}}}