Effect of nurse counselling on metabolic risk factors in patients with mild hypertension: a randomised controlled trial.

BACKGROUND: Hypertension often clusters with metabolic risk factors and its optimal treatment may involve a number of changes in lifestyle. Nurse-led care regarding lifestyle change may improve outcomes in cardiovascular disease prevention involving. OBJECTIVE: To examine if lifestyle guidance given by a nurse improved components of the metabolic syndrome including blood pressure, lipids and waist circumference. SUBJECTS AND DESIGN: Subjects that participated in a health screening with systolic blood pressure 140-169 mm Hg and diastolic blood pressure 90-99 mm Hg at a minimum of three separate readings treated or not treated with antihypertensive drugs were randomly allocated either to monthly nurse-led lifestyle counselling (intervention group, N=31) or to conventional primary care (control group, N=20) to be followed by lifestyle counselling. RESULTS: The mean (S.D.) baseline and end of study blood pressure was 157 (9)/94 (6) mm Hg and 147 (9)/91 (8) mm Hg, respectively, in the intervention group versus 153 (9)/94 (4) and 143 (10)/92 (8) mm Hg, respectively, in the control group (NS between the groups). Waist circumference increased significantly between baseline and 6 months in the control but not in the intervention (mean difference between the groups, 3.1 cm [95% CI 1.2-5.0], p=0.04) and serum triglyceride concentrations were reduced in the intervention compared with the control group (mean difference, 0.56 mmol/l [95% CI 0.22-0.90], p=0.03). The number of risk factors of the metabolic syndrome was 2.1 (S.D. 1.1) at baseline and 2.6 (S.D. 1.2) at 6 months in the control group versus 2.2 (S.D. 1.1) and 1.9 (S.D. 1.0), respectively, in the intervention group (p=0.01). Change in triglycerides was correlated with change in weight (Pearson's correlation coefficient=0.73, p=0.001) and waist circumference (Pearson's correlation coefficient=0.63, p=0.009) in the control group. CONCLUSION: Nurse counselling did not reduce blood pressure but was associated with a lesser gain in waist circumference and reduced triglyceride concentrations. Metabolic risk factors may worsen rapidly in patients with mild hypertension in the waiting period for lifestyle intervention.