Work-Site Treatment of Hypertension by Specially Trained Nurses

Logan, A. G.; C, Achber; Milne, B.; Campbell, W P; Haynes, R. Brian

doi:10.1016/s0140-6736(79)92397-3

Cited by 127 publications

(73 citation statements)

References 6 publications

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“…15 In a 6-month follow-up randomized controlled trial in Toronto, regular care by physician was compared with worksite care by trained nurses. 16 Patients followed by nurses were more likely to be prescribed BP-lowering treatment and to adhere to such medications, as well as reach targets for BP control. In another trial of similar duration in Mexico, 17 home-delivered health promotion by nurses on top of usual care was associated with 3.31-mm Hg (systolic) and 3.67-mm Hg (diastolic) lower BP in the intervention group compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

“…The median duration of follow-up among those who attended at least one postbaseline visit (25th-75th percentiles) was 6 (3-9) months overall and 4 (2-8) and 8 (3-18) months in the urban and the rural setting, respectively. This duration ranged from <1 to 26 months, was longer in the rural compared with the urban setting (P<.001), was not significantly different in men and women, and was longer for participants from the survey (11 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] …”

Section: Follow-upmentioning

confidence: 99%

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Primary Health Care for Hypertension by Nurses in Rural and Urban Sub‐Saharan Africa

Kengne

Awah

Fezeu

et al. 2009

J of Clinical Hypertension

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To implement a nurse-led protocol for the care of hypertension, 5 clinics were established in Yaounde (urban) and Bafut (rural) in Cameroon. International guidelines were adapted and 10 nurses were trained. The initial cohort of patients was referred from a field survey. The program proceeded for 26 months and 454 patients (45% urban) were registered in the clinics. Relative to urban participants, rural participants were more often women (59% vs 45%, P=.002) and less likely to have diabetes (7.2% vs 41.2%, P<.001). Between baseline and final visits, systolic and diastolic blood pressures dropped by 11.7 mm Hg (95% confidence interval, 8.9-14.4) and 7.8 (95% confidence interval, 5.9-9.6), respectively (P<.001). These changes were consistent in subgroups and after adjustment. Most dropouts occurred around the initial visit and among urban participants and nondiabetics. Nurse-led clinics are effective for improving hypertension care in these settings and require implementation and validation through controlled trials. J Clin Hypertens (Greenwich). 2009;11:564-572. 1 In the year 2000, 12.8% of the total global deaths and 4.4% of the total global disability-adjusted lifeyears were attributable to systolic BP (SBP) levels >115 mm Hg.2 The global population of individuals with hypertension was 972 millions in 2000, and is expected to increase to 60% by 2025.3 By then, 71.2 to 76.0 million men and 75.0 to 79.1 million women with hypertension will be found in sub-Saharan Africa (SSA). This will represent a nearly 50% increase relative to recent estimates. The prevalence of hypertension among adults in SSA varies consistently and has increased significantly over the past 2 to 3 decades. 4 Literature survey indicates that related complications and in particular stroke and heart failure are also becoming increasingly more common in this region.5-7 Decades of research into prevention and control have convincingly demonstrated that sustained BP lowering significantly reduces the risk of BP-related complications.8 Guidelines have been developed and are regularly updated to assist the translation of the scientific evidence into actions that will ultimately reduce the burden of hypertension. The uptake of these

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Section: Discussionmentioning

confidence: 99%

Section: Follow-upmentioning

confidence: 99%

Primary Health Care for Hypertension by Nurses in Rural and Urban Sub‐Saharan Africa

Kengne

Awah

Fezeu

et al. 2009

J of Clinical Hypertension

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“…8 -9 Subsequent studies demonstrated that such systematic approaches to care were actually more effective than those conventionally available in the community. 10 " The assumption that better BP control would be matched by greater reduction in CVD events has encouraged expansion of these and similar programs. However, recent findings indicate that greater BP control is not invariably associated with better health outcomes.…”

mentioning

confidence: 99%

Reduction of cardiovascular disease events by worksite hypertension treatment.

Alderman¹,

Madhavan²,

Davis³

1983

Hypertension

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SUMMARY A retrospective cohort study of hypertensive employees to evaluate the impact of worksite antihypertensive treatment (WST) on cardiovascular disease (CVD) over S'/i years is reported. In a union-sponsored screening from August 1973 to February 1974 hypertensives (S= 160 and/or 95 mm Hg, or on medication) were identified. Of these, standardized criteria were met by 344, of whom 150 chose WST and 194 referred care (RC). The study groups were similar in age and sex composition. Union hospitalization and death records through 1982 revealed that CVD rates were fewer in WST than RC (3.0 vs 5.4/100 person-years; p < 0.01). By contrast, nonCVD rates were similar (8.1 vs 9.6). All-cause mortality rate in WST (0.89) was significantly (p < 0.05) lower than that in RC (1.81), as was the standard mortality ratio (55.1), based on U.S. mortality in 1978. CVD mortality was also lower (0.48 vs 1.10; NS). Persons with an initial blood pressure (BP) < 160/95 mm Hg had CVD event rates that were low and similar in WST and RC (3.6 vs 3.5). However, among those with elevated BP at entry, WST subjects fared significantly better than RC (2.8 vs 6.1; p < 0.001). Furthermore, in WST, previously treated patients with elevated BP at screening experienced one-third the CVD morbidity of their counterparts in RC (3.1 vs 10.8; p < 0.01). These results extend previous evidence that WST is an effective method to achieve BP control and demonstrate that this approach to the management of hypertension alters health outcomes favorably and significantly. had demonstrated that blood pressure (BP) control reduced the incidence of cardiovascular disease (CVD). '~3 At the same time, it was apparent that, despite availability of effective antihypertensive therapy, large numbers of identified and treated hypertensives were not achieving BP control. 4 " 7 In an attempt to overcome this deficiency, several modifications of conventional approaches to the management of hypertension evolved. Among these, programs to provide worksite-based antihypertension treatment attained widespread acceptance. Early studies demonstrated that systematic, protocol-directed care provided at the worksite, primarily under the aegis of a nurse, was safe, acceptable, and achieved a high degree of BP control.8 -9 Subsequent studies demonstrated that such systematic approaches to care were actually more effective than those conventionally available in the community.10 " The assumption that better BP control would be matched by greater reduction in CVD events has encouraged expansion of these and similar programs. However, recent findings indicate that greater BP control is not invariably associated with better health outcomes.12 Therefore, it is of more than academic interest to evaluate the effectiveness of worksite antihypertensive therapy in terms of its impact on CVD morbidity and mortality.To this end, we have applied the method of a retrospective cohort study to compare, over an 8'/2-year period, the morbidity and mortality of hypertensive storeworkers who joined a ...

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“…In one of the earlier trials comparing nurse and doctor management of hypertension, 457 participants were enrolled to compare hypertension management provided by specially trained nurses at the participants workplace and that of GPs (Logan, Milne, Achber, Campbell, & Haynes, 1979). Nurses were permitted to prescribe and adjust medication without doctor approval after having completed an education program in which they were taught to manage hypertension according to a set protocol.…”

Section: Nurse-led Interventions In Hypertensionmentioning

confidence: 99%

“…Nurses were permitted to prescribe and adjust medication without doctor approval after having completed an education program in which they were taught to manage hypertension according to a set protocol. The results indicated that people with hypertension who were managed by a nurse were more likely to be prescribed antihypertensive medication (94.7% v 62.7%), to achieve target blood pressure in six months (48.5% v 27.5%) and be compliant in taking their prescribed medication (67.6% v 49.1%) (Logan et al, 1979).…”

Section: Nurse-led Interventions In Hypertensionmentioning

confidence: 99%

Can a nurse-led intervention program for people with peripheral arterial disease lead to sustained improvement in functional capacity and quality of life?

McLennan¹

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Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis which causes significant morbidity and mortality affecting between 14% and 29% of individuals >70 years of age . Multiple studies have demonstrated an improvement in walking distance in people suffering from symptomatic PAD through exercise therapy. While most studies have examined the results of exercise and risk factor modification programs over a short-term this study sought to identify not only whether a nurse-led intervention program can improve functional capacity and quality of life, but if improvements could be sustained over a longer follow-up term. After a mean follow up time of 52 months, the NLIP group had sustained a 14% mortality rate. This is in keeping with the 5-year predicted mortality found amongst PAD sufferers. 3The results from this study suggest that a nurse-led intervention program for people with PAD can have sustained improvement in pain free walking distance and emotional well-being. Further research is required to identify whether earlier intervention may lead to a reduction in mortality rates in PAD population.4

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Work-Site Treatment of Hypertension by Specially Trained Nurses

Cited by 127 publications

References 6 publications

Primary Health Care for Hypertension by Nurses in Rural and Urban Sub‐Saharan Africa

Primary Health Care for Hypertension by Nurses in Rural and Urban Sub‐Saharan Africa

Reduction of cardiovascular disease events by worksite hypertension treatment.

Can a nurse-led intervention program for people with peripheral arterial disease lead to sustained improvement in functional capacity and quality of life?

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