Improving blood pressure control in primary care: The ImPress study

Area of Science:

• Cardiovascular Health
• Preventive Medicine
• Nursing Practice

Background:

• Hypertension is a major preventable risk factor for cardiovascular disease (CVD), the leading global cause of death.
• Combined hypertension with lifestyle factors like smoking, poor nutrition, inactivity, and excessive alcohol increases CVD risk.
• General practice nurses are well-positioned to promote optimal blood pressure control and lifestyle risk reduction due to ongoing patient relationships.

Purpose of the Study:

• To evaluate the effectiveness of a nurse-led intervention aimed at reducing blood pressure in adults diagnosed with hypertension and exhibiting high cardiovascular risk.
• To explore the impact of this intervention on modifiable lifestyle risk factors and medication adherence.

Main Methods:

• A multi-site, cluster randomized controlled trial involving 20 general practices, randomized to either the intervention or usual care.
• Patients with hypertension and high cardiovascular risk were identified via electronic medical record audits.
• The intervention comprised three in-person and two telephone consultations with a nurse, focusing on lifestyle risk assessment and action planning, alongside general practitioner optimization of pharmacotherapy.

Main Results:

• The primary outcome measured was blood pressure reduction.
• Secondary outcomes included improvements in lifestyle risk factors (smoking, nutrition, physical activity, alcohol consumption), body mass index, and medication adherence.
• Outcome measures were assessed at 6 and 12 months post-intervention.

Conclusions:

• The ImPress study introduces an innovative, proactive approach to identifying high-risk individuals for cardiovascular disease.
• It highlights the potential of general practice nurses in managing blood pressure and reducing cardiovascular risk.
• Successful findings could elevate the nursing role, improve patient health outcomes, influence health policy, and transform blood pressure management in primary care.