Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial

Abstract

Background: The hypertension prevalence rate is increasing but the control rate is unsatisfactory. Nurse-led healthcare may be an effective way to improve outcomes for hypertensive patients but more evidence is required especially at the community level.

Objective: This study aims to establish a nurse-led hypertension management model and to test its effectiveness at the community level.

Design: A single-blind, randomized controlled trial was performed in an urban community healthcare center in China. Hypertensive patients with uncontrolled blood pressure (systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg) were randomly allocated into two groups: the study group (n=67) and the control group (n=67). The nurse-led hypertension management model included four components (delivery system design, decision support, clinical information system and self-management support). Patients in the control group received usual care. Patients in the study group received a 12-week period of hypertension management. The patient outcomes, which involved blood pressure, self-care behaviors, self-efficacy, quality of life and satisfaction, were assessed at three time points: the baseline, immediately after the intervention and 4 weeks after the intervention.

Results: After the intervention, the blood pressure of patients in the study group decreased significantly compared to those in the control group, and the mean reduction of systolic/diastolic blood pressure in the study and control groups was 14.37/7.43mmHg and 5.10/2.69mmHg, respectively (p<0.01). In addition, patients in the study group had significantly greater improvement in self-care behaviors than those in the control group (p<0.01). The study group had a higher level of satisfaction with hypertensive care than the control group (p<0.01). No statistically significant difference in self-efficacy and quality of life was detected between the two groups after the intervention.

Conclusions: The nurse-led hypertension management model is feasible and effective in improving the outcomes of patients with uncontrolled blood pressure at the community level.

Keywords: Hypertension; Management; Model; Nurse; Randomized controlled trial.