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

      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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      Linked Article

      • On Improving Hypertension Treatment Success
        Mayo Clinic ProceedingsVol. 80Issue 1
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          Optimal clinical management of hypertension in the United States remains a remarkably contentious issue despite overwhelming evidence that lowering the blood pressure level is a major factor in decreasing the risk of untoward cardiovascular events.1 Analysis of the hypertensive population of more than 50 million people in the United States exhibited an embarrassing decrease in the number of those who received a diagnosis and therapeutic intervention and subsequently achieved therapeutic success.
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