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 Sex differences in BP control rates are controversial. While studies have reported that women are more likely than men to have uncontrolled HTN, 28 others have indicated an association between female sex and appropriate hypertension management. 22 In our team-based care center, this is the first time that female sex is directly associated with higher HTN control rates. 16,17 Randomized controlled trials are often considered the best scientific evidence for ascertaining efficacy and safety of a treatment. 29,30 Once the evidence is available and guidelines recommend treatments, it is important to assess how such interventions perform in a real-world setting. After all, the reality of patient care in a randomized clinical trial is different from usual clinical practice in many ways. 31 In that sense, the positive results shown here, particularly considering that our study was conducted in a public healthcare setting from a country with limited resources, reinforce the relevance of team-based care on hypertension management. The study design might be a limitation, since we conducted a retrospectively single center study with no control group. Despite that, all medical records are objective, and their completion is exhaustively trained in this center, contributing to reliability of the data. Additionally, although we acknowledge that using a control group would be more appropriate, the positive result found here can foster future studies and help informing the healthcare community about a successful way to manage patients with HTN. Another potential limitation regards to physical activity assessment. Only planned or formal physical activity – walking, running, cycling, swimming, strength training, etc.), was included in our definition. Therefore, daily physical activities were not considered and our sedentary lifestyle results are probably overestimated. Costs of implementation and maintenance need to be taken into account when considering a team-based care for hypertension management. Despite that, economic assessment of this intervention in high-income countries showed that team- based care to improve BP is cost-effective. 32 Same assessments need to be conducted in low-to-middle income countries. Given the positive results of the present study and previous studies involving patients from the same HTN treatment center, 14,16,17,33,34 the format adopted in our service can be a model for other centers handling patients diagnosed with HTN and aiming to implement a team-based strategy. Conclusion In the present study, conducted in a real-world setting, the rate of BP control after a team-based approach to hypertensive patients was 70%. Focus on patients with diabetes, younger than 60 years and males should be given to further improve these results. Author contributions Conception and design of the research, Obtaining financing, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Jardim TSV, Souza ALL, Barroso WKS, Jardim PCBV; Acquisition of data, Analysis and interpretation of the data and Statistical analysis: Jardim TSV, Jardim PCBV. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Universidade Federal de Goiás, Hospital das Clínicas da Universidade Federal de Goiás and Fundação de Apoio ao Hospital das Clínicas da UFG. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hospital das Clínicas da Universidade Federal de Goiás under the protocol number 1822-180. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013.z 1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. 2. 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