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 +/- 10.4 mmHg in the intensive care group and from 132.4 +/- 13.5 to 128.2 +/- 13.0 mmHg 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 3.3 mmHg 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. (C) 2010 Elsevier Masson SAS. All rights reserved.