The Clinical Pathway for Hypertensive Patient of Local Health Unit, Hospitals and General Practitioners, the Milan Experience

Alberto      Donzelli; Donatella      Sghedoni; Francesco      A. Carelli; Saverio      Chirchiglia; Paolo      Manunta

Abstract

The Clinical Pathway (in its complete definition Diagnostic, Clinical and Therapeutic Pathway – Percorso Diagnostico Terapeutico Assistenziale - PDTA), originally started to deal with the newly diagnosed hypertensive patient, developed also recommendations for the first-line drugs in case of specific indications/contraindications and organ damages. It has been developed by a working group of specialists in cardiology, nephrology, internal medicine (faculty included) designated by their hospitals (both public and private accredited), including all the main city hospitals, by general practitioners designated by the Medical Unions SNAMI, FIMMG, SMI and SiMI and by public health doctors belonging to the Local Health Unit of Milan, who have coordinated the proceedings and have guaranteed that possible conflicts of interest of single participants could not interfere with the PDTA, anyway approved by all in July 2009. The PDTA deals with the measuring and self- home-monitoring of blood pressure (BP) and the diagnosis of hypertension; it revises, sometimes “dries up” and rationalizes the recommendations for diagnostic tests and specialist evaluations; it develops prevention and non-pharmacological treatments, proposing also tools for patients and for prescribing correct nutrition and physical activity and a structured program for BP monitoring; but the main feature is the innovations brought in the proposed drug treatment in comparison with the current clinical practice.

Keywords: Cardiovascular risk, anti hypertensive therapy, clinical trial, CA, ACEi, ARB, BB, Diuretics, BPLTTC, RCTs, RCT Syst-Eur, IDNT, LIFE, RENAAL, SCOPE, CHARM, VAL-HEFT, ELITE II, OPTIMAAL, VALIANT, MOSES, thiazidetype (TT), hydrochlorothiazide, indapamide, Tachiarrhytmias, Sick Sinus Syndrome or AV, blocker (risk of orthostatic hypotension), Metildopa, Labetalol (BB), alpha-ADDUCIN, NEDD4L, WNK1