title: Hypertension treatment and control within an independent nurse practitioner setting.
abstract: OBJECTIVE
  To assess blood pressure (BP) control among patients with hypertension managed by nurse practitioners (NPs) vs physicians.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Retrospective medical record reviews were conducted at 3 independent NP-based practices and at 21 physician-based practices. Investigators at each practice identified a sample of patients 18 years or older with a hypertension diagnosis. The primary outcome was controlled BP (<140/90 mm Hg for patients without diabetes mellitus and <130/80 mm Hg for patients with diabetes mellitus). Propensity score matching was used to minimize potential selection bias between NP-treated and physician-treated patients and to balance differences in patient characteristics. Logistic regression analysis was performed to estimate the odds of controlled BP for NP-treated vs physician-treated patients, adjusting for covariates.
  
  
  RESULTS
  The NP-treated sample was composed of 684 patients; their mean age was 54.2 years, 62.6% were female, 59.7% were obese, and 19.2% had diabetes mellitus. Before propensity score matching, physician-treated patients were older, less likely to be female, and more likely to have diabetes. The propensity score-matched cohort (n = 623 in each group) had similar baseline characteristics. Among the NP cohort, 70.5% had controlled BP compared with 63.2% among the physician cohort; the mean number of antihypertensive medications was lower among NP-treated patients (1.6 vs 1.8, P = .01). The adjusted odds of controlled BP were slightly lower for physician-treated patients (odds ratio, 0.76; 95% confidence interval, 0.58-0.99).
  
  
  CONCLUSIONS
  Comparable controlled BP rates were observed among patients with hypertension receiving care from an NP vs a comparison group receiving care from a physician; the groups had similar baseline characteristics. Our findings support the increasingly important role of NPs in primary care.
authors.affiliation: Wright & Associates Family Healthcare, Amherst, NH, USA.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Wright
authors.forename: Joan E
authors.initials: JE
authors.lastname: Romboli
authors.forename: Margaret A
authors.initials: MA
authors.lastname: DiTulio
authors.forename: Jenifer
authors.initials: J
authors.lastname: Wogen
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Belletti
mesh_terms: D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000379:methods; D057216:Propensity Score; D012189:Retrospective Studies