ABC | Volume 115, Nº2, August 2020

Original Article Jardim et al. Real-world team-based care for HTN Arq Bras Cardiol. 2020; 115(2):174-181 Methods Data of all patients with HTN aged 18 years or older, with at least two follow-up visits and attending a multidisciplinary treatment center for HTN in the Central West region of Brazil in June 2017 were retrospectively assessed by convenience. HTN was defined according to the 7th Brazilian Guidelines on Hypertension: (1) office BP  ≥  140 × 90 mmHg; ambulatory BP monitoring ≥ 130 × 80 mmHg; (3) home BP monitoring ≥  135 × 85  mmHg. 13 Patients receiving HTN treatment were also considered hypertensive. The center has been functioning for more than 25 years, dedicated to the treatment of HTN, health professional education and research. Patients with recently diagnosed HTN or those with difficulties to control BP levels are referred to the center and the total number of patients enrolled in the study was 1,701. The multidisciplinary team consists of physicians (general practitioners, cardiologists, endocrinologists and nephrologists), nurses, dietitians, physical therapists, physical educators, psychologists and musical therapists. Aiming to improve treatment compliance and reduce loss of follow-up, the maximum interval between each patient appointment was three months. The maximum interval between two medical visits was six months, and regarding the other healthcare professionals, there was no routine appointments, i.e ., the visits were scheduled according to patient’s needs determined by clinical examination. Additionally, educational and health promotion activities were performed every two weeks with patients. 14,15 Since beginning of this multidisciplinary service, consultations have been registered in a standardized form. All healthcare professionals directly involved in patients’ care were routinely trained to complete this form, ensuring data reliability and reproducibility throughout years. 16,17 Data collection Data of the last visit to the service were collected, regardless of the healthcare specialty. Additionally, the dates of patient’s first visit registered in medical charts were collected and used to calculate the follow-up time (difference between the first and the last visit to the service), in years. The following data were collected from the medical records: sex; age: given in years and assessed by the difference between birth date and date of last visit; anthropometric data: weight, height and body mass index (BMI) calculated using the Quetelet formula (BMI = weight in kg/height 2 in meter). Nutritional status was classified according to BMI and following the World Health Organization definitions: non- overweight (BMI < 25kg/m 2 ); overweight (BMI ≥ 25 kg/m 2 and < 30mg/kg 2 ) and obese (BMI ≥ 30 mg/kg 2 ). BP: a minimum of three BP measurements, with at least 1-min interval, was taken. All measurements were performed after 5 minutes of rest, on the upper limb, with the individual sitting and the arm supported. Appropriate cuffs were used depending on arm diameter. Mean values of the last two measurements were considered for BP control definition. BP measurements were performed with oscillometric devices (OMRON semi-automatic equipment, model HEM-705CP). This routine was adopted in the service to avoid observer bias. Lifestyle: smoking (current smoker or nonsmoker); alcohol consumption (any alcohol consumption reported during the last visit); leisure physical activity (regular: ≥3 times a week, irregular: <3 times a week and sedentary: no activity). Diabetes: definition followed the recommendations of the most recent guidelines of the Brazilian Society of Diabetes: 18 (1) symptoms of polyuria, polydipsia, weight loss and casual blood glucose  (values obtained at any time of the day regardless of meal times) ≥  200  mg/dL; (2) fasting blood glucose ≥  126  mg/dL; diagnosis should be confirmed by repeat testing on another day in case of small blood sugar elevations; (3) 2-hour plasma glucose value after a 75-g oral glucose tolerance test ≥ 200 mg/dL. Diabetes treatment registered in medical records was also considered as diagnosis criteria. Drug treatment: information whether patient was receiving or not pharmacological HTN treatment and the number of antihypertensive medications. BP control definitions Recommendations of the 7th Brazilian Guidelines on hypertension (2016) 19 were adopted (BP values < 140 x 90 mmHg in non-diabetics and < 130 x 80 mmHg in diabetic patients) for analysis of BP control. Multidisciplinary service Medical team: assessed symptoms, lifestyle habits and use of medications; performed patients’ physical examination; analyzed complementary tests and established patient management (pharmacological and nonpharmacological treatments prescription, complementary tests request, and follow-up visits schedule); referred patients to emergency care or hospitalization if acute clinical decompensation was identified. Nurses: assessed symptoms, vital signs, lifestyle habits and use of medications; instructed about compliance to both pharmacological and nonpharmacological treatments; defined intervals of visits to the nurse; and referred patients for medical consultation if clinically necessary or to ensure a maximum interval of six months between two medical visits. Dietitians: emphasized nonpharmacological aspects of care, specifically the diet; collected dietary data; assessed anthropometric data and vital signs. Management was aimed at dietary guidance with emphasis on salt restriction and prescription of diets for patients with specific diagnosis such as diabetes and chronic kidney disease. Physical educators: developed and assist patients in group physical activities (strength training and aerobic exercise) three times a week and emphasized the importance of regular physical activity. The other health care professionals did not conduct formal appointments, but rather a series of educational interventions to promote patients’ health. Physical therapists conducted periodical meetings previously scheduled or saw with patients at the waiting room and discussed preventive measures for 175