Nurse-led Disease Management for Hypertension Control in a Diverse Urban Community: a Randomized Trial
- 6 December 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 27 (6), 630-639
- https://doi.org/10.1007/s11606-011-1924-1
Abstract
Treated but uncontrolled hypertension is highly prevalent in African American and Hispanic communities. To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager. Randomized controlled effectiveness trial. Four hundred and sixteen African American or Hispanic patients with a history of uncontrolled hypertension. Patients with blood pressure ≥150/95, or ≥140/85 for patients with diabetes or renal disease, at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City. Patients were randomized to receive usual care or a home blood pressure monitor plus one in-person counseling session and 9 months of telephone follow-up with a registered nurse. During the trial, the home monitor alone arm was added. Change in systolic and diastolic blood pressure at 9 and 18 months. Changes from baseline to 9 months in systolic blood pressure relative to usual care was -7.0 mm Hg (Confidence Interval [CI], -13.4 to -0.6) in the nurse management plus home blood pressure monitor arm, and +1.1 mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm. No statistically significant differences in systolic blood pressure were observed among treatment arms at 18 months. No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18 months. Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm. A nurse management intervention combining an in-person visit, periodic phone calls, and home blood pressure monitoring over 9 months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.Keywords
This publication has 35 references indexed in Scilit:
- The Hypertension Paradox — More Uncontrolled Disease despite Improved TherapyThe New England Journal of Medicine, 2009
- Lifestyle Interventions Reduce Coronary Heart Disease RiskCirculation, 2009
- Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in United States Adults Between 1988–1994 and 1999–2004Hypertension, 2008
- Characteristics of inner-city African-Americans with uncontrolled hypertensionJournal of the American Society of Hypertension, 2008
- Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension ControlJama-Journal Of The American Medical Association, 2008
- Hypertension Management in Minority Communities: A Clinician SurveyJournal of General Internal Medicine, 2007
- Quality Improvement Strategies for Hypertension ManagementMedical Care, 2006
- Factors Associated with Physical Activity Among African-American Men and WomenAmerican Journal of Preventive Medicine, 2006
- Interventions used to improve control of blood pressure in patients with hypertensionPublished by Wiley ,2006
- Lifestyle Intervention: Results of the Treatment of Mild Hypertension Study (TOMHS)Preventive Medicine, 1995