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

2016-10

Carrington, Melinda J

Jennings, Garry L

Harris, Mark

Nelson, Mark R

Schlaich, Markus

Stocks, Nigel P

Burrell, Louise M

Amerena, John

de Looze, Ferdinandus J

Swemmer, Carla H

Kurstjens, Nicol P

Stewart, Simon

on behalf of the VIPER-BP Study investigators

Nurse management

Blood pressure

Hypertension

Primary care

Journal Article

0000-0003-1863-7539

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.

link

European Journal of Cardiology Nursing 2016; 15(6): 409-416

European Journal of Cardiology Nursing