Effect of an intensive nurse-managed medical care programme on ambulatory blood pressure in hypertensive patients.
BACKGROUND
Uncontrolled hypertension is a major primary healthcare problem.


OBJECTIVE
To investigate whether blood pressure (BP) control in primary care could be improved by nurses taking responsibility for managing hypertensive patients.


METHODS
Randomized trial with two groups: usual or intensive care. Patients diagnosed previously as hypertensive and with a systolic office BP greater than 140mmHg were randomized to an intensive care programme managed by trained nurses or to usual care. The intensive care programme included a visit every 6 weeks to the general practitioner's office, with standardized BP measurement, self-measurement training, risk factor checks and advice on BP reduction. The intervention lasted for 1 year. The primary endpoints were systolic BP obtained by 24-hour ambulatory BP monitoring after 1 year and the change compared with baseline.


RESULTS
Two hundred patients from 19 physicians were enrolled (102 in the intensive care group). Data on ambulatory BP were available from 140 patients. Systolic BP declined from 134.4+/-14.0 to 126.3+/-10.4mmHg in the intensive care group and from 132.4+/-13.5 to 128.2+/-13.0mmHg in the usual care group. There was no statistically significant difference in values after 1 year (p=0.332). The reduction in systolic BP was significantly greater in the intensive care group (7.6 vs 3.3mmHg in the usual care group; p=0.036). Similar results were observed for diastolic BP and day- and night-time measurements.


CONCLUSIONS
An intensive medical care programme in the office setting managed by trained nurses can improve BP control effectively. Nurses could take more responsibility for managing hypertensive patients.
Ulm
Kurt
K
Institut für Medizinische Statistik und Epidemiologie, Technische Universität Munich, Ismaningerstr.22, 81675 Munich, Germany. kurt.ulm@tum.de
Huntgeburth
Ulrich
U
Gnahn
Hans
H
Briesenick
Claus
C
Pürner
Klaus
K
Middeke
Martin
M
D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D006302:Health Services Research; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D011320:Primary Health Care / Q000458:organization & administration