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Blood pressure reduction in difficult-to-control patients and the effect of a nurse-led program in Bulgaria
Greta Koleva1, Irinka Hristova1, Despina Georgieva1
1Ruse University "Angel Kanchev", Department of Health care, Faculty of public health and health care, Bulgaria.
Insights
A nurse-led program significantly reduced blood pressure (BP) in patients with uncontrolled hypertension within six months. This intervention improved hypertension control rates, offering a promising strategy for primary care management.
Area of Science:
- Cardiology
- Public Health
- Nursing Practice
Background:
- Hypertension is a leading cause of cardiovascular disease, with suboptimal blood pressure control remaining a significant challenge.
- Despite advancements, effective strategies for managing uncontrolled hypertension are crucial for reducing morbidity and mortality.
Purpose of the Study:
- To assess the impact of a comprehensive nurse-led program on reducing blood pressure in patients with uncontrolled hypertension.
- To evaluate improvements in hypertension control rates and related health indicators.
Main Methods:
- A prospective study involving 47 patients with uncontrolled hypertension (BP > 140/90 mmHg) managed in a cardiologist's office.
- The nurse-led program included patient education, lifestyle counseling, medication adherence support, and quality of life assessments over six months.
- Statistical analysis involved t-tests, chi-square, correlation, and multivariate regression to evaluate BP changes and influencing factors.
Main Results:
- Mean blood pressure decreased significantly from 162/88 mmHg to 133/77 mmHg within six months.
- Hypertension control rates improved dramatically from 2% to 79% by the sixth month (p<0.0001).
- Reduced systolic BP correlated with decreased waist circumference, and BP changes were linked to self-assessed health and renal function.
Conclusions:
- A tailored, nurse-led program effectively lowers blood pressure and enhances hypertension control in primary care settings.
- This intervention demonstrates potential cost-effectiveness and applicability in low- to middle-income countries for improving population blood pressure management.
Abstract:
Hypertension is a major contributor to cardiovascular morbidity and mortality. Although there has been significant improvement in blood pressure (BP) control during the last decades, it is still far from optimal. Several strategies for hypertension management have been proposed, and among all - nurse-led programs seem encouraging.
Aim:
To evaluate the effect of a complex nurse program aiming to reduce BP in patients with uncontrolled hypertension.
Patients And Methods:
In a cardiologist's office, a trained nurse included patients with uncontrolled hypertension and newly referred patients with high BP in a program for hypertension management. It consisted of patient education, assessment of quality of life, lifestyle advice, medication improvement and adherence stimulation. All patients were followed for 6 months and their BP, lifestyle indicators, and quality of life measurements were recorded. Statistical analyses included two- and one sample t-tests, chi-square test, correlation and multivariate linear regression.
Results:
Overall, 47 patients, presenting with uncontrolled hypertension and with BP>140/90 mm Hg were included in this research. Their BP was reduced within 6 months by mean 30 /11 mm Hg and after 6 months, from 162/88 to 133/77 mm Hg. The drop of BP values was present at the first month with mean BP 140/82 mm Hg. Control of hypertension improved from 2% to 55% at the 1st month mark and to 79% at the 6th month, p<0.0001. The decrease in SBP was positively correlated to decrease in waist circumference, p = 0.47, p = 0.009. In multivariate linear regression analysis, the difference in BP was significantly related to self-assessment health scoring and marginally significant with renal impairment.
Conclusions:
The development of a complex nurse-led program, tailored to patients with uncontrolled hypertension, leads to significant positive effect on BP decrease and improves hypertension control in primary care. This may be cost effective and improve BP control in low- to middle-income countries.
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