Management of uncontrolled hypertension in a nurse-led clinic compared with conventional care for patients with type 2 diabetes
Management of uncontrolled hypertension in a nurse-led clinic compared with conventional care for patients with type 2 diabetes
复制标题
DOI：
10.2337/diacare.26.8.2256
复制
发表时间：
2003-08-01
期刊：
影响因子：
16.2
通讯作者：
Earle, KA
中科院分区：
文献类型：
--
作者：
Denver, EA;Barnard, M;Earle, KA
研究设计与方法：研究设计与方法：我们研究了120名男性和女性门诊患者(61%为非高加索人)，他们患有2型糖尿病，坐位血压大于或等于140/80毫米汞柱。所有患者都在接受高血压治疗，71%的患者尿白蛋白排泄量(UAE)增加。患者被分配到由护士领导的高血压诊所或传统的初级护理。主要的结果衡量指标是收缩压的变化。次要观察指标为总胆固醇、高密度脂蛋白胆固醇、总甘油三酯、糖化血红蛋白(1c)、尿毒症、血肌酐，以及绝对中风和冠心病风险评分的变化。结果：平均(95%CI)的收缩压降低差值为12.6mmHg(5.9%~19.3%)(P=0.000)，护理组患者达到目标收缩压的可能性是常规护理组的三倍(P=0.003)。10年冠心病(P=0.004)和卒中风险(P=0.000)得分的显著下降仅发生在由护士领导的组。在6个月时，舒张压下降或任何其他次要结果指标均无显著差异。结论：与传统护理相比，护士指导的高血压门诊对2型糖尿病和未控制的高血压患者是更有效的干预措施。收缩压140毫米汞柱的目标更容易实现，这可能与10年来心血管疾病风险评分的显著降低有关。
OBJECTIVE - To compare the effectiveness of a nurse-led hypertension clinic with conventional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS - We studied 120 men and women outpatient attendees (61% non-Caucasian) with type 2 diabetes and a seated blood pressure (BP) greater than or equal to 140/80 mmHg. All patients were being treated for hypertension, and 71% had increased urinary albumin excretion (UAE). Patients were allocated to either a nurse-led hypertension clinic or conventional primary care. The primary outcome measure was a change in systolic BP. Secondary outcome measures were total cholesterol, HDL cholesterol, total triglycerides, HbA(1c), UAE, serum creatinine, and changes in absolute stroke and coronary heart disease (CHD) risk scores.RESULTS - The mean (95% Cl) difference in the decrement of systolic BP was 12.6 mmHg (5.9-19.3) (P = 0.000) in favor of the nurse-led group, whose patients were three times more likely to a reach target systolic BP < 140 mmHg compared with conventional care (P = 0.003). A significant fall in 10-year CHD (P = 0.004) and stroke risk (P = 0.000) scores occurred only in the nurse-led group. There were no significant differences in the reduction of diastolic BP or any of the other secondary outcome measures at 6 months.CONCLUSIONS - Compared with conventional care, a nurse-led hypertension clinic is a more effective intervention for patients with type 2 diabetes and uncontrolled hypertension. A target systolic BP < 140 mmHg is more readily achieved and may be associated with significant reductions in 10-year cardiovascular disease risk scores.