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Journal of General Internal Medicine

, Volume 27, Issue 6, pp 630–639 | Cite as

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

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

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

hypertension randomized trial minority nurse management home blood pressure monitor 

Notes

ACKNOWLEDGEMENTS

This work was conducted while Dr. Hebert was Assistant Professor at Mount Sinai School of Medicine, Department of Health Policy. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Contributors

None.

Funders

Agency for Healthcare Research and Quality (5P01HS010859-050001), and National Institutes of Health National Center for Minority Health and Health Disparities (1P60MD000270-01).

Prior Presentations

Academy Health Annual Research Meeting, June 2007.

Conflicts of Interest

None disclosed

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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Paul L. Hebert
    • 1
    • 8
    Email author
  • 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

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