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. Aim. - 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 140 mmHg 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.