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Nurse-led Disease Management for Hypertension Control in a Diverse Urban Community: a Randomized Trial
Journal of General Internal Medicine, 12/08/2011
Hebert PL et al. - A nurse management intervention combining an in-person visit, periodic phone calls, and home blood pressure monitoring over 9 months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.
Methods- Randomized controlled effectiveness trial.
- Four hundred and sixteen African American or Hispanic patients with a history of uncontrolled hypertension.
- Patients with blood pressure ≥150/95, or ≥140/85 for patients with diabetes or renal disease, at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City.
- Patients were randomized to receive usual care or a home blood pressure monitor plus one in-person counseling session and 9 months of telephone follow-up with a registered nurse.
- During the trial, the home monitor alone arm was added.
- Change in systolic and diastolic blood pressure at 9 and 18 months.
- Changes from baseline to 9 months in systolic blood pressure relative to usual care was -7.0 mm Hg (Confidence Interval [CI], -13.4 to -0.6) in the nurse management plus home blood pressure monitor arm, and +1.1 mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm.
- No statistically significant differences in systolic blood pressure were observed among treatment arms at 18 months.
- No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18 months.
- Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm.
