title: Evaluation of a specialist nurse-led hypertension clinic with consultant backup in two inner city general practices: randomized controlled trial.
abstract: BACKGROUND
  Although practice nurses are increasingly involved in hypertension management, there is little robust evidence of effectiveness.
  
  
  OBJECTIVE
  To evaluate the effect of a specialist nurse-led hypertension clinic with consultant backup on change in systolic blood pressure.
  
  
  METHODS
  Randomized trial.
  
  
  METHODS
  Two inner city general practices. Participants. Three hundred and fifty-three patients, mean age 62 years (range 18-99), with last recorded blood pressure ≥ British Hypertension Society audit standard were randomly allocated to the nurse-led clinic or usual care. Intervention. Patients received a letter informing them that their last blood pressure was over target and inviting them to the clinic. After assessment at the clinic, the nurse discussed any changes in anti-hypertensive treatment with a visiting consultant and the patient's GP, and followed up the patient over 6 months until blood pressure targets were achieved.
  
  
  METHODS
  Reduction in systolic blood pressure, assessed using two audits of the practices' computerized records where blood pressure was measured independently by practice staff before and after the intervention period.
  
  
  RESULTS
  Follow-up was 89% (313/353). There was greater reduction in systolic blood pressure in the clinic group (n = 144) than usual care group (n = 169, adjusted difference 4.4 mmHg; 95% CI 0.7 to 8.2). Of 167 patients randomly selected for the clinic, 91 (55%) attended, 49 had blood pressure above target when measured according to protocol and 26 had their anti-hypertensive treatment intensified by their GP.
  
  
  CONCLUSIONS
  Invitation to a specialist nurse-led hypertension clinic with consultant back up was associated with reduced systolic blood pressure.
authors.affiliation: Population Health Sciences and Education, St George's, University of London, London, UK.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Dean
authors.forename: Sally M
authors.initials: SM
authors.lastname: Kerry
authors.forename: Teck K
authors.initials: TK
authors.lastname: Khong
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Kerry
authors.forename: Pippa
authors.initials: P
authors.lastname: Oakeshott
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods; D057184:Practice Patterns, Nurses'; D016896:Treatment Outcome; D006113:United Kingdom; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents
keywords: Clinical trial; hypertension; nurse-led clinic; primary care.