Evaluation of a specialist nurse-led hypertension clinic with consultant backup in two inner city general practices: randomized controlled trial.

BACKGROUND: Although practice nurses are increasingly involved in hypertension management, there is little robust evidence of effectiveness. OBJECTIVE: To evaluate the effect of a specialist nurse-led hypertension clinic with consultant backup on change in systolic blood pressure. DESIGN: Randomized trial. SETTING: Two inner city general practices. Participants. Three hundred and fifty-three patients, mean age 62 years (range 18-99), with last recorded blood pressure ≥ British Hypertension Society audit standard were randomly allocated to the nurse-led clinic or usual care. Intervention. Patients received a letter informing them that their last blood pressure was over target and inviting them to the clinic. After assessment at the clinic, the nurse discussed any changes in anti-hypertensive treatment with a visiting consultant and the patient's GP, and followed up the patient over 6 months until blood pressure targets were achieved. MAIN OUTCOME MEASURE: Reduction in systolic blood pressure, assessed using two audits of the practices' computerized records where blood pressure was measured independently by practice staff before and after the intervention period. RESULTS: Follow-up was 89% (313/353). There was greater reduction in systolic blood pressure in the clinic group (n = 144) than usual care group (n = 169, adjusted difference 4.4 mmHg; 95% CI 0.7 to 8.2). Of 167 patients randomly selected for the clinic, 91 (55%) attended, 49 had blood pressure above target when measured according to protocol and 26 had their anti-hypertensive treatment intensified by their GP. CONCLUSION: Invitation to a specialist nurse-led hypertension clinic with consultant back up was associated with reduced systolic blood pressure.

Pilot study of potential barriers to blood pressure control in patients with inadequately controlled hypertension.

BACKGROUND: Most people with high blood pressure (BP) are managed in primary care, but BP control is often inadequate. OBJECTIVES: To examine potential barriers to adequate BP control in patients with poorly controlled hypertension. DESIGN: Cross-sectional survey. SETTING: Computerized inner city general practice. PARTICIPANTS: A total of 155 hypertensive patients aged 50-80 years with last recorded BP > or =150/90 mm Hg (or > or =140/85 mm Hg if diabetic). METHODS: Patients were invited to attend a nurse-led clinic where BP was measured according to a standardized protocol and patients were asked to complete a semi-structured questionnaire including lifestyle, compliance with treatment and knowledge about hypertension. Details of BP reviews were obtained from medical records. RESULTS: A total of 110 patients (71%) with a mean age of 65 years attended the nurse-led clinic of whom 27% were of African origin. Of those who attended, 52 (47%) had adequately controlled BP when measured according to protocol. The remaining 58 (53%) had inadequately controlled BP. Of patients on treatment, 94% (83/88) reported taking it at least 6 days a week. Only 9% of patients knew their target BP and only 39% that treatment aims to prevent stroke or heart attack. Patients with diabetes were more likely than those without to have BP > or = audit standard (79% 26/33 versus 42% 32/77, P < 0.001). CONCLUSION: About half of apparently uncontrolled hypertensive patients had BP below target when measured according to standard methods. Reported compliance was good, but patient knowledge of target BP was poor. Patients with diabetes were more likely than those without to have inadequately controlled BP.