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Nurse management for hypertension. A systems approach
Peter Rudd1, Nancy Houston Miller, Judy Kaufman
1Department of Medicine, Stanford University, Stanford, California, USA.
American Journal of Hypertension
|October 16, 2004
Summary
A nurse-managed, home-based system significantly improved hypertension control by enabling frequent blood pressure monitoring and medication adjustments. This approach enhanced patient adherence and reduced blood pressure more effectively than usual care.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Nursing Practice
Background:
- Standard office-based hypertension management shows limited success due to inadequate patient education and infrequent blood pressure monitoring.
- Suboptimal hypertension control highlights the need for improved patient support and regular monitoring systems.
Purpose of the Study:
- To test the efficacy of a physician-directed, nurse-managed, home-based system for hypertension management.
- To evaluate the impact of standardized algorithms for drug therapy modulation based on home blood pressure readings.
Main Methods:
- Randomized outpatients requiring hypertension drug therapy into usual care (UC) or nurse care management intervention (INT) groups for 6 months.
- Intervention group received nurse management with standardized algorithms for medication adjustments based on home BP monitoring.
Main Results:
- Patients in the INT group achieved significantly greater reductions in office systolic and diastolic blood pressure compared to the UC group.
- Nurse-managed patients had more frequent medication therapy changes (97% vs. 43%) and higher adherence rates (80.5% vs. 69.2%).
- No significant adverse drug reactions were reported in either group.
Conclusions:
- Telephone-mediated nurse management effectively addresses systemic and patient-related barriers to pharmacotherapeutic success in hypertension.
- Home-based, nurse-managed interventions can significantly improve blood pressure control and medication adherence.
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