Improved Blood Pressure Control With a Physician-Nurse Team and Home Blood Pressure Measurement

Canzanello, Vincent J.; Jensen, Patricia L.; Schwartz, Lora L.; Worra, Joel B.; Klein, Lois K.
January 2005
Mayo Clinic Proceedings;Jan2005, Vol. 80 Issue 1, p31
Academic Journal
OBJECTIVE: To assess whether a physician-nurse team model could improve long-term hypertension control rates by active Intervention and modification of antihypertensive drug regimens based on home blood pressure (BP) measurements. PATIENTS AND METHODS: This study consisted of patients referred to a hypertension specialty clinic between July 1999 and June 2002 for the evaluation and management of uncontrolled hypertension. Patients were evaluated initially by a physician, A treatment plan was designed and implemented subsequently by a hypertension nurse specialist. Each patient was given an automated digital home BP monitor and requested to provide 42 BP readings taken during 7 days at intervals of 1, 3, 6, 9, and 12 months after dismissal from the clinic. The mean of these weekly values was reviewed by the physician-nurse team, and the treatment regimen was adjusted to achieve a goal BP of less than 135/85 mm Hg. RESULTS: One hundred six consecutively referred patients were enrolled in the study (mean ± SD age, 64±14 years; 58% female; baseline BP. 156±16/85±11 mm Hg). Ninety-four patients submitted BP data after 1 month, and 78 patients completed the entire 12-month study period. Overall, mean BP decreased to 138+17/78+8 mm Hg at 1 month and to 131±9/75±7 mm Hg at 12 months (P<.01 vs baseline). The percentage of patients who achieved BP control to less than 135/85 mm Hg increased from 0% at baseline to 63% at 12 months. Intensification of antihypertensive drug therapy was required, on average, in 24% of patients at each study interval. The mean number of drugs increased from 1.2 at baseline to 2.0 at 12 months (P<.01). CONCLUSION: The use of home BP measurement by a physiciannurse team has the potential to significantly improve long-term hypertension control rates In a geographically dispersed patient population. This model should reduce both cost and inconvenience associated with the treatment of hypertension.


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