Addressing the Hypertension Burden in China: A Randomized Trial of CDSS

Hypertension is a major global health concern, particularly in China, where many adults have hypertension, but treatment and control rates are low. Despite evidence-based guidelines, antihypertensive medication use is often suboptimal.

Improving the performance of primary care doctors is a key solution for better blood pressure control. However, limited resources, uneven distribution of healthcare professionals, and inadequate training pose significant challenges.

A cost-effective and scalable solution, like a Clinical Decision Support System (CDSS), could potentially enhance the performance of primary care physicians. However, CDSS adoption is low in China, and studies in India have shown mixed results.

S. James Adelstein Professor of Health Care Policy, Sharon-Lise Normand, collaborated with a team of researchers on a recent study published in the BMJ. The study aimed to assess the impact of CDSS on guideline-adherent antihypertensive treatment, blood pressure change, and control in Chinese primary care settings. 

The study randomly assigned 94 primary care practices to one of two groups: half implemented a CDSS, while the other half continued with non-CDSS care. Researchers then followed 12,137 patients with hypertension to observe their treatment by the doctors in these practices.

Key takeaways:

  • Improved Guideline Adherence: Doctors using the CDSS prescribed guideline-based hypertension medication more frequently than those providing usual care.
  • Reduced Systolic Blood Pressure: Patients treated with the CDSS approach experienced a slightly larger decrease in systolic blood pressure.
  • Increased Blood Pressure Control: A small increase in the proportion of patients achieving controlled blood pressure was observed in the CDSS group.
  • Safety: No significant difference in reported side effects from hypertension medications was found between the two groups.

Overall, the study suggests that using a CDSS in primary care can be a safe and effective way to improve hypertension treatment and blood pressure control in China, particularly given the country's resource constraints and uneven distribution of healthcare professionals.