title: Frequent nurse visits decrease white coat effect in stage III hypertension.
abstract: Arterial hypertension is a public health problem and patient adherence to treatment is challenging. This study tested whether frequent nurse visits provide additional benefits to antihypertensive treatment. Every 30 days, a pharmacist visited these patients to deliver antihypertensive drugs and perform a pill count. Nurses visited group A (48 patients) every 15 days and group B (52 patients) every 90 days. Ambulatory blood pressure (BP) monitoring was performed 15 and 180 days after randomization. At randomization, groups A and B had the same clinical systolic (191 +/- 5 v 186 +/- 3 mm Hg) and diastolic BP levels (122 +/- 3 v 117 +/- 4 mm Hg), respectively. After 90 days, BP declined more in group A than in group B (35 +/- 5/19 +/- 3 v 27 +/- 5/9 +/- 3 mm Hg). At 180 days, the difference increased because the reduction persisted in group A but decreased in group B (36 +/- 6/21 +/- 4 v 17 +/- 4/10 +/- 2 mm Hg). The mean ambulatory BP monitoring values were similar in both groups at 15 and 180 days. However, the attenuation of the clinic-daytime BP difference was larger in group A than in group B (systolic, -13 +/- 4 v -3 +/- 4 mm Hg; diastolic -11 +/- 3 v -4 +/- 3 mm Hg). The patients with clinic-daytime differences decreased more in group A (systolic, 16 to 10; diastolic, 20 to 14) than in group B (systolic, 19 and 20; diastolic, 22 and 22). These data indicate that frequent nurse visits significantly attenuate the white coat effect (clinic daytime BP difference).
authors.affiliation: Hypertension Unit-Heart Institute, Faculty of Medicine of the University of São Paulo, São Paulo SP, Brazil.
authors.forename: Grazia Maria
authors.initials: GM
authors.lastname: Guerra-Riccio
authors.forename: Dante Marcelo
authors.initials: DM
authors.lastname: Artigas Giorgi
authors.forename: Fernanda Marciano
authors.initials: FM
authors.lastname: Consolin-Colombo
authors.forename: José Augusto Soares
authors.initials: JA
authors.lastname: Barreto-Filho
authors.forename: Heno Ferreira
authors.initials: HF
authors.lastname: Lopes
authors.forename: Ana Lúcia Rego
authors.initials: AL
authors.lastname: Fleury Camargo
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moacyr Krieger
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000553:Ambulatory Care; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D001938:Brazil; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000451:nursing* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013599:Systole / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers