Carrington, M. J, Jennings, G. L, Harris, M., Nelson, M., Schlaich, M., Stocks, N. P, Burrell, L. M, Amerena, J., de Looze, F. J, Swemmer, C. H, Kurstjens, N. P & Stewart, S. (2016). 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. European Journal of Cardiovascular Nursing,15(6), 409-416. United Kingdom: Sage Publications Ltd.. Retrieved from https://doi.org/10.1177/1474515115591901
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.
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