title: Nurse-led disease management for hypertension control in a diverse urban community: a randomized trial.
abstract: BACKGROUND
  Treated but uncontrolled hypertension is highly prevalent in African American and Hispanic communities.
  
  
  OBJECTIVE
  To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager.
  
  
  METHODS
  Randomized controlled effectiveness trial.
  
  
  METHODS
  Four hundred and sixteen African American or Hispanic patients with a history of uncontrolled hypertension. Patients with blood pressure ≥150/95, or ≥140/85 for patients with diabetes or renal disease, at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City.
  
  
  METHODS
  Patients were randomized to receive usual care or a home blood pressure monitor plus one in-person counseling session and 9 months of telephone follow-up with a registered nurse. During the trial, the home monitor alone arm was added.
  
  
  METHODS
  Change in systolic and diastolic blood pressure at 9 and 18 months.
  
  
  RESULTS
  Changes from baseline to 9 months in systolic blood pressure relative to usual care was -7.0 mm Hg (Confidence Interval [CI], -13.4 to -0.6) in the nurse management plus home blood pressure monitor arm, and +1.1 mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm. No statistically significant differences in systolic blood pressure were observed among treatment arms at 18 months. No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18 months. Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm.
  
  
  CONCLUSIONS
  A nurse management intervention combining an in-person visit, periodic phone calls, and home blood pressure monitoring over 9 months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.
authors.affiliation: Department of Health Services, University of Washington School of Public Health, Washington, DC, USA. heberp@u.washington.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.forename: Jane E
authors.initials: JE
authors.lastname: Sisk
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Casabianca
authors.forename: Velvie A
authors.initials: VA
authors.lastname: Pogue
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Wang
authors.forename: Yingchun
authors.initials: Y
authors.lastname: Chen
authors.forename: Christine
authors.initials: C
authors.lastname: Cowles
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: McLaughlin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D003376:Counseling / Q000458:organization & administration; D019468:Disease Management; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology / Q000451:nursing* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009732:Nursing Care / Q000592:standards; D013689:Telephone; D019037:Urban Health Services / Q000458:organization & administration*
chemical_list: D000959:Antihypertensive Agents