The authors investigated the role of poor drug adherence in treatment-resistant hypertension following observed drug ingestion in 102 patients. Median blood pressures (BPs) were 170/91 mm Hg at referral, 153/84 mm Hg prior to, and 142/79 mm Hg during a 4-to 6-hour period after drug ingestion. Median daytime ambulatory BP monitoring (ABPM) over the following 24 hours was 142/80 mm Hg. Median BP at a final follow-up clinic visit was 147/ 79 mm Hg. The cumulative number of patients achieving a goal of <140/90 mm Hg in clinic or <135/85 mm Hg mean on ABPM was 57 (56%), with a further nine (9%) controlled at the final follow-up clinic visit. Thus, 65% of patients achieved a systolic BP <140 mm Hg at any point immediately prior to, or after, drug ingestion; the residual 35% were considered to have true resistant hypertension. In conclusion, among patients with suspected resistant hypertension, a minority were truly treatment-resistant following observed drug ingestion and BP monitoring.
During 2003-2004, six nurses from a London-based acute care trust undertook supplementary and independent nurse prescribing courses. After completing the courses, an action learning set was created in order to address the nurses’ need for continuing professional development. Some of the benefits of this group included shared learning and group problem-solving of practice issues. In this article the authors describe the practical steps to implement an action learning set, the benefits to its members and its impact on clinical practice.
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