Key result
A nurse-managed, home-based system for hypertension management achieved greater reductions in office systolic blood pressure at 6 months compared to usual care (14.2 vs 5.7 mm Hg; P<0.01).
Why the study?
Does a physician-directed, nurse-managed, home-based system for hypertension management improve blood pressure reduction and medication adherence in outpatients requiring drug therapy for hypertension?
RCT (n=150)
Does a physician-directed, nurse-managed, home-based system for hypertension management improve blood pressure reduction and medication adherence in outpatients requiring drug therapy for hypertension?
Absolute Event Rate: 14.2% vs 5.7%
p-value: p=<0.01
A telephone-mediated, nurse-managed home blood pressure monitoring system significantly improves blood pressure reduction and medication adherence compared to usual care.
Supports implementation of nurse-managed home BP monitoring in outpatients; extends RCT evidence for remote hypertension management.
BACKGROUND: Standard office-based approaches to controlling hypertension show limited success. Such suboptimal hypertension control reflects in part the absence of both an infrastructure for patient education and frequent, regular blood pressure (BP) monitoring. We tested the efficacy of a physician-directed, nurse-managed, home-based system for hypertension management with standardized algorithms to modulate drug therapy, based on patients' reports of home BP. METHODS: We randomized outpatients requiring drug therapy for hypertension according to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria to receive usual medical care only (UC, n = 76) or usual care plus nurse care management intervention (INT, n = 74) over a 6-month period. RESULTS: Patients receiving INT achieved greater reductions in office BP values at 6 months than those receiving UC: 14.2 +/- 18.1 versus 5.7 +/- 18.7 mm Hg systolic (P < .01) and 6.5 +/- 10.0 versus 3.4 +/- 7.9 mm Hg diastolic, respectively (P < .05). At 6 months, we observed one or more changes in drug therapy in 97% of INT patients versus 43% of UC patients, and 70% of INT patients received two or more drugs versus 46% of UC. Average daily adherence to medication, measured by electronic drug event monitors, was superior among INT subjects (mean +/- SD, 80.5% +/- 23.0%) than among UC subjects (69.2 +/- 31.1%; t(113) = 2.199, P = .03). There were no significant adverse drug reactions in either group. CONCLUSIONS: Telephone-mediated nurse management can successfully address many of the systems-related and patient-related issues that limit pharmacotherapeutic effectiveness for hypertension.
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Rudd et al. (2004) conducted an RCT in Hypertension (n=150). Usual care plus nurse care management intervention vs. Usual medical care only was evaluated on Reduction in office systolic blood pressure (p=<0.01). A nurse-managed, home-based system for hypertension management achieved greater reductions in office systolic blood pressure at 6 months compared to usual care (14.2 vs 5.7 mm Hg; P<0.01).
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