title: Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: Insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study.
abstract: Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain.
  
  
  
  To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels.
  
  
  
  We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%); practice nurse-mediated usual care (n=156, 10.5%); standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared.
  
  
  
  Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3%; p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78; p=0.001).
  
  
  
  There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia Baker IDI Heart and Diabetes Institute, Melbourne, Australia melinda.carrington@acu.edu.au.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Garry L
authors.initials: GL
authors.lastname: Jennings
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.affiliation: School of Medicine and Pharmacology, Royal Perth Hospital Unit, The University of Western Australia, Australia.
authors.forename: Markus
authors.initials: M
authors.lastname: Schlaich
authors.affiliation: Discipline of General Practice, University of Adelaide, Australia.
authors.forename: Nigel P
authors.initials: NP
authors.lastname: Stocks
authors.affiliation: Departments of Medicine and Cardiology, The University of Melbourne, Austin Health, Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Burrell
authors.affiliation: Geelong Cardiology Research Department, Deakin University, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Amerena
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Ferdinandus J
authors.initials: FJ
authors.lastname: de Looze
authors.affiliation: Novartis Pharmaceuticals Australia Ltd, Sydney, Australia.
authors.forename: Carla H
authors.initials: CH
authors.lastname: Swemmer
authors.affiliation: Novartis Pharmaceuticals Australia Ltd, Sydney, Australia.
authors.forename: Nicol P
authors.initials: NP
authors.lastname: Kurstjens
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009732:Nursing Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents
keywords: Nurse management; blood pressure; hypertension; primary care