[Evaluation of costs and effectiveness of an integrated outpatient training program for hypertensive patients].

BACKGROUND: Clinical management of hypertension needs a comprehensive therapeutic approach including both somatic and psychological aspects to ensure long-term treatment success. We have developed and evaluated an integrated outpatient training program for hypertensive patients.
METHODS: The impact of the integrated training program was evaluated in an open label prospective single-center study of 120 consecutive patients. The outpatient training program consisted of moderate physical exercise, patient education (relaxation techniques and stress management) and individual psychotherapy as indicated. Training sessions were held twice weekly during the initial six-month period. Anti-hypertensive medications were managed by the program director in close cooperation with the primary care physician. Hypertension control, medication and program costs were monitored prospectively. Evaluated parameters were measured at study enrolment (T1), upon completion of the six-month program (T2) and at follow-up at 18 +/- 5 months (T3).
RESULTS: Maximum exercise capacity increased from 85.1 +/- 1.3% at enrolment (T1) to 95.8 +/- 1.5% of the expected value at 6 months (T2) (p < 0.005). There was no change in body mass index, though a reduction in anti-hypertensive medication was observed (betablockers, -30.1%; thiazides, -20.9%; ACEI/ARB, -19.8%; calcium channel antagonist, -13.4%; alpha-blockers, -41.5%; p < 0.05; p < 0.01). Blood pressure fell from 144.6 +/- 1.8/ 88.1 +/- 0.9 at enrolment (T1) to 136.8 +/- 1.4/83.5 +/- 0.8 mm Hg at 6 month (T2) (p < 0.01). A similar decrease in systolic blood pressure at submaximal workload of 8.5 +/- 1.4 (6.6-11.2) mm Hg was observed. The daily costs for anti-hypertensive medications decreased 20.7% from EUR 0.92 to 0.73 (p < 0.01). The overall costs for the program were EUR 970 per patient. At follow-up at 18 +/- 5 months (T3), there was persistence in the reduction in medication use as well as an increase in exercise capacity. Blood pressure control had deteriorated but the values were lower than at enrolment (T1) (p = 0.1, p < 0.05).
CONCLUSION: The integrated training program represents a comprehensive and effective approach to the treatment of hypertension. The costs of the program are likely to be offset by reduced expenses for anti-hypertensive medications over time at least in part.