Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study

Carrington, Melinda J., Jennings, Garry L., Harris, Mark, Nelson, Mark, Schlaich, Markus, Stocks, Nigel P., Burrell, Louise M., Amerena, John, De Looze, Ferdinandus J., Swemmer, Carla H., Kurstjens, Nicol P. and Stewart, Simon (2016) Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. European Journal of Cardiovascular Nursing, 15 6: 409-416. doi:10.1177/1474515115591901


Author Carrington, Melinda J.
Jennings, Garry L.
Harris, Mark
Nelson, Mark
Schlaich, Markus
Stocks, Nigel P.
Burrell, Louise M.
Amerena, John
De Looze, Ferdinandus J.
Swemmer, Carla H.
Kurstjens, Nicol P.
Stewart, Simon
Title Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study
Journal name European Journal of Cardiovascular Nursing   Check publisher's open access policy
ISSN 1873-1953
1474-5151
Publication date 2016-10-01
Year available 2015
Sub-type Article (original research)
DOI 10.1177/1474515115591901
Open Access Status Not yet assessed
Volume 15
Issue 6
Start page 409
End page 416
Total pages 8
Place of publication London, United Kingdom
Publisher Sage Publications
Language eng
Abstract Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain.

To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels.

We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%); practice nurse-mediated usual care (n=156, 10.5%); standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared.

Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3%; p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78; p=0.001).

There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
Formatted abstract
Background: Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain.

Aims: To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels.

Methods: We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%); practice nurse-mediated usual care (n=156, 10.5%); standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared.

Results: Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ≤125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3%; p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78; p=0.001).

Conclusion: There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
Keyword Blood pressure
Hypertension
Nurse management
Primary care
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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