Is a Shared Decision–Making Approach Effective in Improving Hypertension Management?


Roland E. Schmieder, MD, University of Erlangen-Nuremberg, Department of Nephrology and Hypertension, Krankenhausstraße 12, 91054 Erlangen, Germany


The authors assessed whether patient empowerment in the management of hypertension improved more with the practice of shared decision making (SDM) than by education programs. In a prospective controlled clinical study, 15 general practitioners in Nuremberg, Germany who were specially trained to conduct SDM consultations participated in a 12-month study. Hypertensive patients (N=86) were included; N=40 were in the SDM group and N=46 were in the control group, if blood pressures were ≥135/85 mm Hg (self measurement) and patients had no signs of cardiovascular complications or severe hypertension. All participants in the SDM group and the control group were enrolled in an education program on hypertension in small groups. The SDM group participants also had 4 special consultations to share medical decisions. The main outcome measures were the effect of SDM on blood pressure control. After 1 year blood pressure had decreased in all participants: Δ−9.26±10.2 mm Hg/Δ−5.33±9.5 mm Hg in the SDM group (P<0.001) compared to Δ−6.0±11.8 mm Hg/Δ−3.0±8.3 mm Hg in the control group. There was no significant difference between the 2 groups. The study group practiced more SDM than controls, but blood pressure control was not significantly better. Patient empowerment by means of an education program in small groups and creating awareness of hypertensive disease helps to improve the outcome of hypertension treatment. SDM, however, did not improve management when compared to an education program, which is much easier to implement in general practice.