Physician-nurse team improves blood pressure control

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Success in achieving target blood pressure levels seems to be improved using home blood pressure measurements to guide treatment in a physician-supervised, nurse-managed clinic, a new study suggests.

It is estimated that fewer than half of people who are taking medication for High Blood Pressure actually have their condition under control, Dr. Vincent J. Canzanello and colleagues at Mayo Clinic College of Medicine in Rochester, Minnesota, point out in the journal Mayo Clinic Proceedings.

The team developed their new approach in hopes of reducing the inconvenience and cost related to blood pressure monitoring.

The study included 106 patients who first attended the Hypertension Care Clinic for several days in a row. A drug treatment plan was drawn up for each of the patients, and they were educated about hypertension and cardiovascular disease preventive measures.

The subjects were then instructed to measure their blood pressure twice daily at home for a 7-day period at 1, 3, 6, 9, and 12 months. The results were sent to the clinic nurse and drug treatment was intensified if blood pressure readings were not less than 135/85.

With this strategy, the percentage of patients who achieved this target level of blood pressure control increased from 0 percent at the start of the study to 63 percent after one year.

“This model should reduce both cost and inconvenience associated with the treatment of hypertension,” Canzanello’s group suggests.

“Too often, patients with hypertension are ‘fit into’ the course of a busy practitioner’s day through a series of visits over weeks to months, and patients never receive the focused attention necessary at the outset of care,” Dr. Andrew B. Covit, at UMDNJ-Robert Wood Johnson Medical School in South River, New Jersey, maintains in an accompanying editorial.

He believes that the approach described by Canzanello and colleagues emphasizes to patients “the true gravity of the disease and its future implications.”

SOURCE: Mayo Clinic Proceedings, January 2005.

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