Nurse‐led management of uncontrolled hypertension in those with diabetes and high vascular risk

Abstract

The aim of this audit was to determine the effectiveness of a protocol driven, nurse‐led hypertension service for patients with diabetes at high risk. Data for this audit were collected prospectively on referred patients with established diabetes complications and suboptimal hypertension control. Antihypertensive agents were sequentially introduced and dose titrated according to protocol. Patients were discharged once the target systolic blood pressure (SBP) of <140mmHg was achieved or the intended sequence of drug therapy was complete. In all, 124 patients completed the full process. There were significant reductions in SBP (186±24 to 139±12mmHg, p<0.001) and diastolic blood pressure (85±13 to 67±11mmHg, p<0.001). A total of 61% achieved the target SBP of <140mmHg. There were expected increases in the number of antihypertensive agents and the number of agents used to maximum dose. Estimated coronary heart disease risk for the primary prevention group improved significantly despite non‐significant changes in lipid profiles. It was concluded that a systematic approach combining a pre‐set drug protocol itself and its timely implementation under adequate surveillance in a nurse‐led hypertension clinic led to effective outcomes. Copyright © 2007 John Wiley & Sons.

Diabetes specialist nursing in the UK: the judgement call? A review of existing literature

“…This resulted in a mean fall in systolic BP from 186±24mmHg at baseline to 139±12mmHg post intervention (p<0.001); mean diastolic BP also fell from 85±13mmHg to 67±11mmHg post intervention. 28 A total of 61% of participants achieved the target systolic BP of <140mmHg. 28 Glycosylated haemoglobin A significant reduction in HbA 1c levels was demonstrated in two studies; a reduction from a mean of 9.3±1.7% (range 7.5-14.2) at baseline to 7.5±1.1% (range 5.4-10.6) post intervention was shown in the first Liverpool study (p=0.001).…”

“…28 A total of 61% of participants achieved the target systolic BP of <140mmHg. 28 Glycosylated haemoglobin A significant reduction in HbA 1c levels was demonstrated in two studies; a reduction from a mean of 9.3±1.7% (range 7.5-14.2) at baseline to 7.5±1.1% (range 5.4-10.6) post intervention was shown in the first Liverpool study (p=0.001). 25 Mean HbA 1c was recorded as 8.4±1.8% at baseline and 8.0±1.7% at discharge in the Wolverhampton study (p<0.01).…”

“…17,18 Two distinct themes emerged: six articles related to inpatient care ( Table 2)2, 19-23 and five to diabetes nurse-led clinics. [24][25][26][27][28] All were quantitative studies, initiated and delivered insecondary care.…”

“…All studies used systolic blood pressure (BP), BP management and serum cholesterol levels as primary outcome measures. [24][25][26][27][28] Two studies also used HbA 1c as an outcome measure. 25,28 Lipid management…”

“…25 Mean HbA 1c was recorded as 8.4±1.8% at baseline and 8.0±1.7% at discharge in the Wolverhampton study (p<0.01). 28 …”