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Type: Journal article
Title: 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
Author: Carrington, M.
Jennings, G.
Harris, M.
Nelson, M.
Schlaich, M.
Stocks, N.
Burrell, L.
Amerena, J.
de Looze, F.
Swemmer, C.
Kurstjens, N.
Stewart, S.
Citation: European Journal of Cardiovascular Nursing, 2016; 15(6):409-416
Publisher: SAGE Publications
Issue Date: 2016
ISSN: 1474-5151
Statement of
Melinda J Carrington, Garry L Jennings, Mark Harris, Mark Nelson, Markus Schlaich, Nigel P Stocks, Louise M Burrell, John Amerena, Ferdinandus J de Looze, Carla H Swemmer, Nicol P Kurstjens and Simon Stewart, on behalf of the VIPER-BP Study investigators
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
Rights: © The European Society of Cardiology 2015
DOI: 10.1177/1474515115591901
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