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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
Carrington, MJ and Jennings, GL and Harris, M and Nelson, M and Schlaich, M and Stocks, NP and Burrell, LM and Amerena, J and de Looze, FJ and Swemmer, CH and Kurstjens, NP and Stewart, S, on behalf of the VIPER-BP Study investigators, 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, European Journal of Cardiovascular Nursing, 15, (6) pp. 409-416. ISSN 1474-5151 (2016) [Refereed Article]
© The European Society of Cardiology 2015
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.
|Item Type:||Refereed Article|
|Keywords:||nurse management, blood pressure, hypertension, primary care|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Cardiovascular medicine and haematology|
|Research Field:||Cardiology (incl. cardiovascular diseases)|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Nelson, M (Professor Mark Nelson)|
|Year Published:||2016 (online first 2015)|
|Web of Science® Times Cited:||6|
|Deposited By:||Menzies Institute for Medical Research|
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