Management of Hypertensive Patients by CNS in a Military Setting

Many patients do not control their hypertension (HTN) despite its contribution to cardiovascular morbidity and mortality and increased health care costs. This randomized clinical trial tested the effectiveness of a comprehensive educational-behavioral intervention by a clinical nurse specialist. The control group received the usual care available in a military setting. Blood pressures were measured before the intervention and at 6, 12, and 24 months.

A total of 232 subjects were screened and 147 consented for baseline data collection. Complete data were collected on 112 subjects at 6 months, 94 at 12 months, and 27 at 24 months. Mean age was 61 years with more males than females; mean education level was 14 years; 89.8% were married; 59.2% were retired; most were U.S. Air Force members or dependents. No demographic differences were found between the treatment and control groups.

HTN knowledge improved in both groups, but not significantly. At 6 months, the treatment group showed a slight but not statistically significant improvement in adherence to medication regimen, communication skills, and satisfaction with health care providers. Both groups showed slight changes in lifestyle indicators; no lifestyle differences were seen between the two groups at baseline or at 6 months.

No differences were found in systolic or diastolic BP at baseline. At 6 months, mean systolic and diastolic BPs had decreased in both groups and the proportion with controlled BP increased. At 24 months, mean systolic and diastolic BPs in the treatment group had decreased significantly whereas the controls showed a steady increase in systolic pressure.

Left ventricular mass (LVM) and renal albumin were also examined. Both groups had non-significant improvement in LVM. The treatment group showed no decrease in albumin. The groups did not differ in albumin, creatinine, or the ratio of the two, at baseline or at 6 months.

Final Report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013104...