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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
Carrington, Melinda Jane Jennings, Garry L. Harris, Mark Nelson, Mark Schlaich, Markus Stocks, Nigel P. Burrell, Louise M. Amerena, John de Looze, Ferdinandus J. Swemmer, Carla H.
Carrington, Melinda Jane
Jennings, Garry L.
Harris, Mark
Nelson, Mark
Schlaich, Markus
Stocks, Nigel P.
Burrell, Louise M.
Amerena, John
de Looze, Ferdinandus J.
Swemmer, Carla H.
Abstract
Background: Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain. Aims: To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels. Methods: 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. Results: 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). Conclusion: There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
Keywords
nurse management, blood pressure, hypertension, primary care
Date
2016
Type
Journal article
Journal
European Journal of Cardiovascular Nursing
Book
Volume
15
Issue
6
Page Range
409-416
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled