BACKGROUND: Hypertension often clusters with metabolic risk factors and its optimal treatment may involve a number of changes in lifestyle. Nurse-led care regarding lifestyle change may improve outcomes in cardiovascular disease prevention involving. OBJECTIVE: To examine if lifestyle guidance given by a nurse improved components of the metabolic syndrome including blood pressure, lipids and waist circumference. SUBJECTS AND DESIGN: Subjects that participated in a health screening with systolic blood pressure 140-169 mm Hg and diastolic blood pressure 90-99 mm Hg at a minimum of three separate readings treated or not treated with antihypertensive drugs were randomly allocated either to monthly nurse-led lifestyle counselling (intervention group, N=31) or to conventional primary care (control group, N=20) to be followed by lifestyle counselling. RESULTS: The mean (S.D.) baseline and end of study blood pressure was 157 (9)/94 (6) mm Hg and 147 (9)/91 (8) mm Hg, respectively, in the intervention group versus 153 (9)/94 (4) and 143 (10)/92 (8) mm Hg, respectively, in the control group (NS between the groups). Waist circumference increased significantly between baseline and 6 months in the control but not in the intervention (mean difference between the groups, 3.1 cm [95% CI 1.2-5.0], p=0.04) and serum triglyceride concentrations were reduced in the intervention compared with the control group (mean difference, 0.56 mmol/l [95% CI 0.22-0.90], p=0.03). The number of risk factors of the metabolic syndrome was 2.1 (S.D. 1.1) at baseline and 2.6 (S.D. 1.2) at 6 months in the control group versus 2.2 (S.D. 1.1) and 1.9 (S.D. 1.0), respectively, in the intervention group (p=0.01). Change in triglycerides was correlated with change in weight (Pearson's correlation coefficient=0.73, p=0.001) and waist circumference (Pearson's correlation coefficient=0.63, p=0.009) in the control group. CONCLUSION: Nurse counselling did not reduce blood pressure but was associated with a lesser gain in waist circumference and reduced triglyceride concentrations. Metabolic risk factors may worsen rapidly in patients with mild hypertension in the waiting period for lifestyle intervention.
BACKGROUND: Poor adherence to antihypertensive drug regimens is believed to be a major contributor to treatment failure. Electronic monitoring of adherence may improve adherence and allow differentiation between those who are nonadherent and those who are pharmacologically nonresponsive. This study was designed to evaluate the effectiveness of electronic monitoring of adherence in lowering blood pressure (BP) in comparison with usual care. METHODS: A total of 258 patients with high BP despite use of antihypertensive medication were randomly assigned to either continuation of usual care (with adjustment in antihypertensive medication if necessary) or to the introduction of electronic monitoring. Adherence to antihypertensive medication was monitored for 2 months without medication changes. The primary outcome measure was the proportion of patients who reached target BP levels after a 5-month follow-up period. RESULTS: At 5 months, 50.6% of the patients in the usual care group reached adequate BP, v 53.7% in the electronic monitoring group (P = .73). The percentages of patients with drug additions or increases in dosage were higher in the usual care group compared with those in whom adherence was monitored (P < .01). CONCLUSION: These data show that electronic monitoring in comparison to usual care results in similar BP control but leads to fewer drug changes and less drug use. This result is likely to be achieved by improving adherence. Hence a strategy that includes electronic monitoring has the potential to prevent unnecessary treatment escalation in patients with poor adherence.
The authors examined the effects of a comprehensive lifestyle modification intervention on blood pressure (BP) and other cardiovascular risk factors in hypertensive patients. A total of 70 participants were randomly placed into either a lifestyle intervention or a control group. Four education classes and individual counseling sessions were held for the intervention group. Participants in the control group were provided with routine outpatient services and were asked to maintain their usual lifestyle. Data were gathered at baseline and at the end of 6 months. At the end of 6 months, BP, body weight, body mass index, waist circumference, and fasting lipids, apart from high-density lipoprotein cholesterol, significantly declined in the intervention group. Health-promoting lifestyle scores of the intervention group had increased significantly compared to those of the control group. In conclusion, the results demonstrate the feasibility of comprehensive lifestyle modification and show its beneficial effects. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
STUDY OBJECTIVE: To measure the effectiveness of a multifaceted educational intervention to improve ambulatory hypertension control. DESIGN: Cluster-randomized trial. SETTING: Academic health system using an ambulatory electronic medical record. SUBJECTS: A total of 10,696 patients with a diagnosis of hypertension cared for by 93 primary care providers. INTERVENTION: Academic detailing, provision of provider-specific data about hypertension control, provision of educational materials to the provider, and provision of educational and motivational materials to patients. MEASUREMENTS AND MAIN RESULTS: The primary outcome was blood pressure control, defined as a blood pressure measurement below 140/90 mm Hg, and was ascertained from electronic medical records over 6 months of follow-up. We determined the adjusted odds ratio for the association between the intervention and the achievement of controlled blood pressure. When we accounted for clustering by provider, this adjusted odds ratio was 1.13 (95% confidence interval 0.87-1.47). Adjusted odds ratios were 1.03 (95% confidence interval 0.78-1.36) in patients whose blood pressure was controlled at baseline and 1.25 (95% confidence interval 0.94-1.65) in those whose blood pressure was not. These odds ratios were not significantly different (p=0.11). CONCLUSIONS: These results were consistent with no effect or, at best, a relatively modest effect of the intervention among patients with hypertension. Had we not included a concurrent control group, the data would have provided an unduly optimistic view of the effectiveness of the program. The effectiveness of future interventions may be improved by focusing on patients whose blood pressure is uncontrolled at baseline.
BACKGROUND: First Nations people with diabetes mellitus and hypertension are at greater risk of renal and cardiovascular complications than are non-native patients because of barriers to health care services. We conducted this randomized controlled trial to assess whether a community-based treatment strategy implemented by home care nurses would be effective in controlling hypertension in First Nations people with existing hypertension and type 2 diabetes. METHODS: We compared 2 community-based strategies for controlling hypertension in First Nations people with existing hypertension and diabetes. In the intervention group, a home care nurse followed a predefined treatment algorithm of pharmacologic antihypertensive therapy. In the control group, treatment decisions were made by each subject's primary care physician. The primary outcome measure was the difference between the 2 groups in the change in systolic blood pressure after 12 months. Secondary outcome measures were the change in diastolic blood pressure over time, the change in urine albumin status and the incidence of adverse events. RESULTS: Both groups experienced a significant reduction in systolic blood pressure by the final visit (by 24.0 [standard deviation (SD) 13.5] mm Hg in the intervention group and by 17.0 [SD 18.6] mm Hg in the control group); p < 0.001 in each case). However, the difference between the 2 groups in this change was not significant. Patients in the intervention group had a larger decrease in diastolic blood pressure over time than did those in the control group (by 11.6 [SD 10.6] mm Hg v. 6.8 [SD 11.1] mm Hg respectively; p = 0.05). The groups did not differ significantly in terms of changes in urine albumin excretion or incidence of adverse events. INTERPRETATION: High rates of blood pressure control in the community were achieved in both groups in the DREAM 3 study. The addition of a home care nurse to implement a treatment strategy for blood pressure control was more effective in lowering diastolic than systolic blood pressure compared with home care visits for blood pressure monitoring alone and follow-up treatment by a family physician.
BACKGROUND: Pharmaceutical care programs may be an option to improve blood pressure (BP) control in patients with uncontrolled hypertension. The aim of this study was to evaluate the efficacy of pharmaceutical care programs in treating patients with resistant hypertension. METHODS: In a double-blind randomized clinical trial, 71 patients with uncontrolled BP were enrolled in a pharmaceutical care program or in a control group and underwent a series of cognitive tests. The primary outcome was change in ambulatory BP (ABP) between the baseline evaluation and the final visit 6 months later. The secondary outcomes were the frequency of drug-related problems and adherence as determined by plasma levels of hydrochlorothiazide. RESULTS: The delta-values between the intervention and control groups for ABP in the different daily periods, with the corresponding 95% confidence limits, adjusted for age and baseline BP were: 3 (-1 to 5), 2 (-2 to 4), and 5 (-1 to 6) mm Hg for 24 h, daily and nightly systolic BP, respectively. The corresponding values for diastolic BP were 1 (-1 to 3), 0 (-2 to 2), and 3 (-1 to 4) mm Hg, respectively. Hydrochlorothiazide was detected in the plasma in 21 of 27 patients in the intervention group that attended to all appointments and 24 of 30 patients in the control group (P = .904). CONCLUSIONS: The pharmaceutical care program tested in this trial was feasible and showed a trend for better BP control in patients with uncontrolled hypertension.
BACKGROUND: Hypertension is generally poorly controlled in primary care. One possible intervention for improving control is the harnessing of patient expertise through education and encouragement to challenge their care. AIM: To determine whether encouraging patients to manage their hypertension in an 'expert' manner, by providing them with information in a clear clinical guideline, coupled with an explicit exhortation to become involved in and to challenge their own care if appropriate, would improve their care. DESIGN OF STUDY: Single blind randomised controlled trial of detailed guideline versus standard information. SETTING: Single urban general practice over 1 year. METHOD: Patient-held guideline with written explicit exhortation to challenge care when appropriate. Two hundred and ninety-four of 536 eligible patients on the practice hypertension register were recruited, all of whom were randomised into one of two groups. Two hundred and thirty-six patients completed the study. RESULTS: Primary outcome: average systolic blood pressure. Secondary outcomes: proportion of patients with blood pressure < 150 mmHg systolic and < 90 mmHg diastolic, average cholesterol, proportion of patients prescribed statins and aspirin according to guideline, hospital anxiety and depression score. No clinically, or statistically significant differences were found between intervention and control with respect to all parameters or in anxiety and depression levels. Statin and aspirin use improved throughout the course of the study in both groups. Statin use showed a trend (P = 0.02) in favour of control. CONCLUSION: In this study there was no clinically significant perceived benefit to patients as a result of providing them with a hypertension guideline. Patient guidelines are currently planned for many chronic illnesses. It is important to determine the utility of such interventions before scarce resources are applied to them.
OBJECTIVE: To evaluate the effectiveness of self-measurement of blood pressure (SMBP) in controlling hypertension. DESIGN: Randomized, controlled, pragmatic, open study. The unit of randomization was the basic health care unit (BCU), consisting of 1 physician and 1 nurse. All BCUs were randomized to the control group (usual clinical practice, n=94) or to the intervention group (n=86). SETTING: Primary care BCUs throughout Spain. PARTICIPANTS: Patients with poorly controlled essential hypertension, defined as systolic blood pressure > or = 140 or diastolic blood pressure > or = 90 mm Hg. INTERVENTIONS: The patients were given an OMRON HEM-705CP automatic blood pressure monitor on two occasions, for use during 15 days at weeks 6 and 14. Blood pressure was recorded at each visit (baseline, 6, 8, 14, 16, and 24 weeks). Main outcome measures. MAIN OUTCOME VARIABLE: control of blood pressure, considered systolic/diastolic blood pressure <140/90 mm Hg (130/85 in patients with diabetes). RESULTS: 180 BCUs serving 1325 patients (622 in the intervention group, 703 in the control group) participated. Baseline characteristics were similar in both groups. Immediately after the first period of SMBP (week 8) the proportion of patients whose blood pressure was well controlled was 7.6% higher in the intervention group than in the control group (P=.01). After the second period of SMBP (week 16) the difference between groups decreased to 4.1% (P=.27). At the end of the study the difference was 4.9% (P=.19). CONCLUSIONS: Self-measurement of blood pressure was effective in controlling blood pressure in the short term, but its effects faded over time.
BACKGROUND: Lack of medication adherence is a common reason for poor control of blood pressure in the community, increasing the risk of heart attacks and strokes. OBJECTIVE: To evaluate the effect of nurse-led adherence support for people with uncontrolled high blood pressure compared with usual care. METHODS: We recruited 245 women and men with uncontrolled hypertension (≥150/90 mmHg) from 21 general practices in Bristol, UK. Participants were randomized to receive nurse-led adherence support or usual care alone. Main outcome measures were adherence to medication ('timing compliance') and blood pressure. RESULTS: Mean baseline timing compliance (± SD) was high in both the intervention (90.8 ± 15.6%) and the control group (94.5 ± 7.6%). There was no evidence of an effect of the intervention on timing compliance at follow-up (adjusted difference in means -1.0%; 95% confidence interval (CI) -5.1 to 3.1). There was also no difference at follow-up between the groups with regard to systolic blood pressure (-2.7 mmHg; 95% CI -7.2 to 1.8) or diastolic blood pressure (0.2 mmHg; 95% CI -1.9 to 2.3). Projected costs for the primary care sector per consultation were £6.60 for the intervention compared with £5.08 for usual care. CONCLUSION: In this study, adherence to blood pressure medication was much higher than previously reported. There was no evidence of an effect of nurse-led adherence support on medication adherence or blood pressure compared with usual care. Nurse-led adherence support was also more expensive from a primary care perspective. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
BACKGROUND: The majority of hypertensive patients do not reach the target blood pressure (BP). We sought to clarify whether intermittent self-monitoring of BP leads to better BP control compared to ordinary treatment in general practice. METHODS: Two hundred sixty-nine hypertensive patients participated in this multicenter, randomized, parallel-group study in primary health care. Home BP was measured in the self-monitoring (SM) group at 0, 2, 4, and 6 months, and in the control (C) group at 0 and 6 months. The participating physicians were instructed to intensify the antihypertensive therapy when needed. RESULTS: At the beginning, both groups had similar home BP levels (SM 143.1 +/- 17.4/85.3 +/- 7.4 mm Hg v C 143.9 +/- 18.3/85.4 +/- 7.5 mm Hg). After 6 months, there were significant decreases in systolic (P <or= .0001), diastolic (P <or= .0029), and pulse pressures (P <or= .021) in both groups. Systolic (-7.8 +/- 13.1 mm Hg v -4.5 +/- 12.2 mm Hg, P = .047) and pulse pressure (-4.7 +/- 9.0 mm Hg v -2.2 +/- 10.0 mm Hg, P = .042) decreased significantly more than in the self-monitoring group. The decrease in diastolic pressure was similar in both groups (SM -3.1 +/- 6.2 mm Hg v C -2.3 +/- 8.3 mm Hg, P = not significant). The patients in the SM group reached home BP target more often than those in the C group (29% v 16%, P = .016). There was a nonsignificant trend toward lower office BP values in the SM group. CONCLUSIONS: Self-monitoring decreased systolic and pulse pressure significantly more than ordinary treatment and promoted achievement of target BP. This was most likely due to improved patient compliance and more active treatment by the physicians. Our results suggest that home measurement is useful in the control of hypertension.
Hypertension often clusters with metabolic risk factors and its optimal treatment may involve a number of changes in lifestyle. Nurse-led care regarding lifestyle change may improve outcomes in cardiovascular disease prevention involving.
OBJECTIVE:
To examine if lifestyle guidance given by a nurse improved components of the metabolic syndrome including blood pressure, lipids and waist circumference.
SUBJECTS AND DESIGN:
Subjects that participated in a health screening with systolic blood pressure 140-169 mm Hg and diastolic blood pressure 90-99 mm Hg at a minimum of three separate readings treated or not treated with antihypertensive drugs were randomly allocated either to monthly nurse-led lifestyle counselling (intervention group, N=31) or to conventional primary care (control group, N=20) to be followed by lifestyle counselling.
RESULTS:
The mean (S.D.) baseline and end of study blood pressure was 157 (9)/94 (6) mm Hg and 147 (9)/91 (8) mm Hg, respectively, in the intervention group versus 153 (9)/94 (4) and 143 (10)/92 (8) mm Hg, respectively, in the control group (NS between the groups). Waist circumference increased significantly between baseline and 6 months in the control but not in the intervention (mean difference between the groups, 3.1 cm [95% CI 1.2-5.0], p=0.04) and serum triglyceride concentrations were reduced in the intervention compared with the control group (mean difference, 0.56 mmol/l [95% CI 0.22-0.90], p=0.03). The number of risk factors of the metabolic syndrome was 2.1 (S.D. 1.1) at baseline and 2.6 (S.D. 1.2) at 6 months in the control group versus 2.2 (S.D. 1.1) and 1.9 (S.D. 1.0), respectively, in the intervention group (p=0.01). Change in triglycerides was correlated with change in weight (Pearson's correlation coefficient=0.73, p=0.001) and waist circumference (Pearson's correlation coefficient=0.63, p=0.009) in the control group.
CONCLUSION:
Nurse counselling did not reduce blood pressure but was associated with a lesser gain in waist circumference and reduced triglyceride concentrations. Metabolic risk factors may worsen rapidly in patients with mild hypertension in the waiting period for lifestyle intervention.
