Journal of General Internal Medicine

, Volume 27, Issue 6, pp 630–639

Nurse-led Disease Management for Hypertension Control in a Diverse Urban Community: a Randomized Trial

  • Paul L. Hebert
  • Jane E. Sisk
  • Leah Tuzzio
  • Jodi M. Casabianca
  • Velvie A. Pogue
  • Jason J. Wang
  • Yingchun Chen
  • Christine Cowles
  • Mary Ann McLaughlin
Original Research

DOI: 10.1007/s11606-011-1924-1

Cite this article as:
Hebert, P.L., Sisk, J.E., Tuzzio, L. et al. J GEN INTERN MED (2012) 27: 630. doi:10.1007/s11606-011-1924-1

ABSTRACT

BACKGROUND

Treated but uncontrolled hypertension is highly prevalent in African American and Hispanic communities.

OBJECTIVE

To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager.

DESIGN

Randomized controlled effectiveness trial.

PATIENTS

Four hundred and sixteen African American or Hispanic patients with a history of uncontrolled hypertension. Patients with blood pressure ≥150/95, or ≥140/85 for patients with diabetes or renal disease, at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City.

INTERVENTION

Patients were randomized to receive usual care or a home blood pressure monitor plus one in-person counseling session and 9 months of telephone follow-up with a registered nurse. During the trial, the home monitor alone arm was added.

MAIN MEASURES

Change in systolic and diastolic blood pressure at 9 and 18 months.

KEY RESULTS

Changes from baseline to 9 months in systolic blood pressure relative to usual care was −7.0 mm Hg (Confidence Interval [CI], -13.4 to −0.6) in the nurse management plus home blood pressure monitor arm, and +1.1 mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm. No statistically significant differences in systolic blood pressure were observed among treatment arms at 18 months. No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18 months. Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm.

CONCLUSIONS

A nurse management intervention combining an in-person visit, periodic phone calls, and home blood pressure monitoring over 9 months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.

KEY WORDS

hypertensionrandomized trialminoritynurse managementhome blood pressure monitor

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Paul L. Hebert
    • 1
    • 8
  • Jane E. Sisk
    • 2
  • Leah Tuzzio
    • 3
  • Jodi M. Casabianca
    • 4
  • Velvie A. Pogue
    • 5
  • Jason J. Wang
    • 2
  • Yingchun Chen
    • 2
  • Christine Cowles
    • 6
  • Mary Ann McLaughlin
    • 7
  1. 1.Department of Health ServicesUniversity of Washington School of Public HealthWashingtonUSA
  2. 2.Department of Health Evidence and PolicyMount Sinai School of MedicineNew YorkUSA
  3. 3.Group Health Research InstituteSeattleUSA
  4. 4.Department of PsychologyFordham UniversityNew YorkUSA
  5. 5.Department of Medicine, Division of NephrologyHarlem Hospital CenterNew YorkUSA
  6. 6.Abt SRBINew YorkUSA
  7. 7.Department of Medicine, Division of CardiologyMount Sinai School of MedicineNew YorkUSA
  8. 8.Veterans Administration Health Services Research and DevelopmentPuget Sound Medical CenterSeattleUSA