Presence of a practice nurse to facilitate an intensive, structured care approach to hypertension management in primary care results in improved adherence to the strategy and better BP control

Purpose: We determined the impact of practice nurses (PN) on BP control within the study intervention arm of the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) Study. Methods: Prospective, multi-centre randomised controlled trial (119 primary care clinics and 2185 participants). A total of 1035 participants were randomly allocated to the study intervention of intensive/structured BP management. Prospectively derived criteria for adherence to the study protocol were compared to BP control during 26 week follow-up. Results: Mean age was 59.2±11.8 years, 61.7% were male and 66.7% had longstanding hypertension. Initial mean BP was 150±17/88±11mmHg with individual BP targets of ≤140/90mmHg, ≤130/80mmHg and ≤125/75mmHg in 29.3%, 53.7% and 17.1% participants, respectively. PNs facilitated the care of 28.7% of participants and clinic attendance was consistently higher (range of 81-95% vs. 79-90%) in this group. Per protocol treatment deviations occurred during 25.8-38.7% of clinic visits; resulting in higher BP levels (p < 0.001) at subsequent visits. Ideal protocol adherence to schedule visits and treatment up-titration was highest in PN clinics (57.1% vs. 46.2%; adjusted OR 2.0, 95% CI 1.02-3.97; p = 0.043). Overall, PNs were associated with lower BP at 26 weeks (132±15/77±10mmHg vs. 136±15/81±10mmHg; p < 0.001) and a greater likelihood to achieve individual BP control (48.4% vs. 31.2%; OR 2.01, 95% CI 1.56-2.74; p < 0.001) and the historical target of ≤140/90 (71.1% vs. 60.3%; OR 1.62, 95% CI 1.20-2.17; p < 0.001). Conclusions: In the VIPER-BP Study, PNs were associated with a marked improvement in applying the study protocol and, consequently, significantly improved BP control in primary care.