Nurse visits may aid blood pressure control

Frequent visits to a nurse may help people gain better control over their high blood pressure, study findings suggest.

Researchers in Brazil found that patients with highly elevated blood pressure who saw a nurse every couple weeks had a bigger blood pressure drop than those who saw one every three months.

Over time, their blood pressure readings also showed less of a "white-coat" effect - the tendency of a person's blood pressure to rise when a doctor is measuring it.

Dr. Eduardo Moacyr Krieger and colleagues at the University of Sao Paulo report the findings in the American Journal of Hypertension.

The study included 48 patients with severe high blood pressure who saw a nurse every 15 days for six months, and 52 patients who saw a nurse twice over the same time period.

All were on blood pressure medication, and at each visit, nurses measured the patients' blood pressure and reminded them of the importance of sticking with their treatment

After three months, patients who frequently saw a nurse had a greater blood pressure decline than those in the other group, and the difference remained after six months, according to the researchers.

There was also evidence that the frequent nurse visits lessened the white-coat effect on patients' blood pressure. A portable monitor was used to measure patients' blood pressure changes over the course of a typical day. For those in the frequent-visit group, the difference between this 24-hour measure and blood pressure readings taken at the doctor's office shrunk by the six-month point.

This suggests that regularly seeing a nurse can help ease the white-coat effect, although the significance of this to a person's health is unclear, Krieger and his colleagues note.

The phenomenon has been attributed to the tension a person may feel when faced with a doctor wielding a blood pressure cuff, and some studies have concluded that the reaction may not mean much in terms of cardiovascular health.

On the other hand, the white-coat effect may not be an "innocent phenomenon," the study authors note, since it tends to go hand-in-hand with other risk factors for cardiovascular disease.

Further studies, they conclude, are needed to see whether frequent nurse visits can improve overall blood pressure control enough to be worth the cost, and to see what benefit there might be to blunting the white-coat effect.

SOURCE: American Journal of Hypertension, June 2004.