No major impact when GPS, nurses implement high blood pressure interventions.

The implementation of lifestyle modifications, home blood pressure measurement, and optimization of antihypertensive drug therapy has been shown to improve hypertension control in tightly controlled research settings. However, would these interventions be effective if performed by family practitioners and nurses in a primary care setting?

A group of researchers set out to explore this premise. They recruited 220 hypertensive patients from 2 health centers that operated in the same building and covered similar populations, with the health centers randomized to function as intervention or control sites.

Participants in the intervention group received repeated, individual and group counseling from the centrally trained staff of the health center on healthy lifestyles. Their antihypertensive drug therapy was also guided by home BP measurements performed at 3-month intervals instead of by conventional office measurements.

After 12 months of follow-up, the differences between the groups as far as lifestyle changes (body mass index, physical activity, dietary recalls, and urinary sodium/potassium) were nominal. Antihypertensive treatment intensity increased in both groups, but the difference was also non-significant. Office systolic/diastolic BP decreased significantly in both groups, but the differences were again non-significant.

The researchers concluded that intervention “did not improve blood pressure control as suggested by many prior studies performed in controlled academic settings. This result could be attributed to a lack of motivation and incentives among the staff or because the population was relatively unselected.” They said there is a need for greater attention to education and financial incentives might be required in typical primary care settings to obtain better results.

In another clinical trial, researchers found that doctors will go the extra mile to help patients control their blood pressure if they are given a financial incentive. The trial involved 83 primary care physicians treating 1,000 patients for hypertension at 12 Veterans Affairs outpatient clinics. The doctors were given a bonus of $1,648 for 20 months ─ 1.6 percent of their annual salary. Results showed an 8.36 percent improvement in patients’ BP control. For an additional 84 patients, the doctors paid to perform, tended to prescribe the right meds and recommend the right lifestyle changes.

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