Lack of long-term effects from a pedagogical intervention upon blood pressure control—a randomized primary care study

OBJECTIVE: The primary aim was to evaluate the effect on blood pressure (BP) levels of a previously developed pedagogically structured BP card introduced to patients with inadequately controlled hypertension in primary care. The evaluation was based on the results of a pilot study which is briefly presented. The aim of the study was to validate the positive results from a pilot study in a different, larger setting, for a longer time, and to study the effects of a nurse-led individual health counseling strategy. DESIGN: A "BP card" that summarized the essential targets of hypertension treatment was presented to patients with a small set of questions. An open, randomized, controlled study was performed testing the effect of the BP card: BP card with an added semi-structured nurse counseling versus usual care (3 groups) during 12 months. RESULTS: The effects on BP levels differed greatly from results seen in the pilot study where BP fell significantly in the intervention group as compared with that in the control group. In the main study, however, BP levels declined more than 25/8.5 mmHg in all three groups, with no significant differences between the groups. CONCLUSION: The positive results in the pilot study could not be confirmed in the main study. Furthermore, the nurse-led individual health counseling strategy did not show any additive effects. The reasons for these discrepant findings may be external such as increased awareness of hypertension, and internal factors such as contamination and non-biased recruitment.