[Management of hypertension in the hypertension clinic]

A recent Cochrane report concluded that an effective system for hypertension control has yet to be identified. This manuscript presents results from four years' work in a nurse-guided hypertension clinic. The aim of the hypertension clinic was to reduce the number of physician-consultations and to optimize hypertension treatment.

All patients were initially examined by physicians. All follow-up visits were performed by the nurses of the hypertension clinic. They initiated and titrated antihypertensive medication according to a treatment algorithm or the physicians' instructions. Blood pressure (BP) measurement and recording of risk profile were performed in accordance with guidelines from the Danish Hypertension Association.

During the four years, 186 patients were treated at the Hypertension Clinic. A total of 130 were discharged to general practice. 95% of these reached their target BP. In all, 56 patients continued treatment at cardiological or nephrological out-patient clinics, or preferred to stop their treatment at the hypertension clinic and refused further referral. Most of the patients received combination therapy with 2-7 different antihypertensive drugs. The three primary antihypertensive drugs were the three first drugs to be used and they comprised the majority of the combination therapy. Many patients received betablockers either as an antihypertensive drug or because of ischemic heart disease.

Despite many risk factors and severe hypertension, 95% of the patients achieved their target BP. We hope the results will inspire physicians and GP's to adapt the concept.