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Guidelines for Drug Therapy of Hypertension: Multi-Site Implementation

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ClinicalTrials.gov Identifier: NCT00122161
Recruitment Status : Completed
First Posted : July 21, 2005
Last Update Posted : April 7, 2015
Information provided by (Responsible Party):

July 18, 2005
July 21, 2005
April 7, 2015
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Primary care clinicians adherence to hypertension guidelines and blood pressure control in their panels of patients.
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Complete list of historical versions of study NCT00122161 on ClinicalTrials.gov Archive Site
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Guidelines for Drug Therapy of Hypertension: Multi-Site Implementation
Guidelines for Drug Therapy of Hypertension: Multi-Site Implementation
Clinical trial of implementation of clinical practice guidelines for managing hypertension in primary care clinics.


Hypertension, the most commonly reported medical problem in veterans, is a major risk factor for heart disease and stroke. Lowering blood pressure decreases the risk of these adverse clinical outcomes. Widely promoted evidence-based clinical practice guidelines set target blood pressures for adequate control, yet most hypertensives, including VA patients, do not meet the targets. Guidelines also call for use of specific drugs depending on the patient's pattern of comorbid characteristics; yet, clinicians often prescribe drugs that are not guideline-concordant.


The long term objective of this work is to contribute to the VA's ability to respond flexibly to rapidly evolving medical knowledge by establishing a system guidelines that can be used throughout the VA nationally for implementing multiple different clinical practice. In collaboration with Stanford Medical Informatics we developed an automated decision support system for hypertension management, known as ATHENA DSS built with EON technology for guideline-based decision support. ATHENA DSS incorporates hundreds of knowledge rules to operationalize guidelines for hypertension.


ATHENA DSS combines patient information from VistA with an automated knowledge base of hypertension to generate patient-specific recommendations for management of hypertension that are displayed to primary care clinicians in pop-up windows in the VA�s Computerized Patient Record System (CPRS) when the record for appropriate patients is opened on the day of scheduled primary care clinic visits. The ATHENA DSS pop-up provides advice on adequacy of control of blood pressure and specific recommendations for drug therapy of hypertension, a visual display of the patient�s medication history and concurrent blood pressures, evidence supporting the main recommendations, and other information. We deployed the system at three VA medical centers--Durham, San Francisco, and Palo Alto�and conducted a clinician-randomized trial. We logged data on use of the system, monitored comments entered by clinicians, and conducted a questionnaire survey of clinicians. We planned analyses of impact on clinician prescribing and patient blood pressures. We planned preparation for dissemination of the system to additional VA medical centers.


Project work is ongoing at time of preparing this report. We recently received notice of funding for a VISN collaborative that will use the ATHENA DSS in five medical centers in VISN 1 (New England).

Phase 3
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
  • Behavioral: ATHENA Decision Support System, An Automated Clinical Decision Support System for Health Care Providers
  • Behavioral: Profiling performance
Arm 1
  • Behavioral: ATHENA Decision Support System, An Automated Clinical Decision Support System for Health Care Providers
  • Behavioral: Profiling performance

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
September 2005
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Inclusion Criteria:

Primary care clinicians at participating study sites. That is physicians, nurse practitioners and physician assistants who have their own panel of patients to whom they provide direct patient care.

Exclusion Criteria:

Sexes Eligible for Study: All
Child, Adult, Senior
Contact information is only displayed when the study is recruiting subjects
United States
CPI 99-275
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VA Office of Research and Development
VA Office of Research and Development
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Principal Investigator: Mary K. Goldstein, MD MS VA Palo Alto Health Care System, Palo Alto, CA
VA Office of Research and Development
October 2007

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP