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Nurse-led management of hypertension

Pippa Oakeshott, Sally Kerry, Sally Dean and Franco Cappuccio
British Journal of General Practice 2005; 55 (510): 53.
Pippa Oakeshott
St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. E-mail:
Roles: Senior Lecturer in General Practice
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  • For correspondence: oakeshot@sghms.ac.uk
Sally Kerry
St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. E-mail:
Roles: Senior Lecturer in Medical Statistics
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  • For correspondence: oakeshot@sghms.ac.uk
Sally Dean
St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. E-mail:
Roles: Research Nurse in Cardiovascular Disease
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  • For correspondence: oakeshot@sghms.ac.uk
Franco Cappuccio
St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. E-mail:
Roles: Professor of Clinical Epidemiology and Primary Care
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  • For correspondence: oakeshot@sghms.ac.uk
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This article has a correction. Please see:

  • Correction - February 01, 2005

In their comprehensive review of recent advances in cardiology in primary care, Fahey and Schroeder1 looked at new models of care including nurse-led management of hypertension. We analysed trials from UK general practices of change in systolic blood pressure after a nurse-led intervention until 2002. These showed a combined reduction in systolic blood pressure of only 3mm Hg — a fall that could just be due to accommodation.2 By contrast the landmark American Hypertension Detection and Follow-up trial showed that an organised system of regular follow up and review of hypertensive patients using a stepped care approach to treatment reduced not only blood pressure but also mortality over 5 years.3 The vital difference between this and the British community-based trials is that it included change in drug treatment to achieve target blood pressure.

The introduction of quality payments is encouraging UK general practices to improve management of people with high blood pressure. Although not yet tested in randomised trials, it is likely that this will involve an enhanced role for practice nurses. This could include adherence to protocols, agreed target blood pressure, better prescribing and compliance, and regular follow up.4 The development of supplementary prescribing by practice nurses will also be important. What a pity that the new NICE (National Institute of Clinical Excellence) recommendations for management of hypertension in primary care fail to include the simple, user-friendly British Hypertension Society ABCD guidelines.5

  • © British Journal of General Practice, 2005.

REFERENCES

  1. ↵
    1. Fahey T,
    2. Schroeder K
    (2004) Cardiology. Br J Gen Pract 54:695–702.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Imperial Cancer Research Fund OXCHECK Study Group
    (1994) Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year. BMJ 308:308–312.
    OpenUrl
  3. ↵
    (1997) Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program cooperative Group. 1979. JAMA 277:157–166.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Oakeshott P,
    2. Kerry S,
    3. Austin A,
    4. Cappuccio F
    (2003) Is there a role for nurse-led blood pressure management in primary care? Fam Pract 20(4):469–473.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Brown MJ,
    2. Cruickshank JK,
    3. Dominiczak AF,
    4. et al.
    (2003) Better blood pressure control: how to combine drugs. J Hum Hypertens 17(2):81–86.
    OpenUrlCrossRefPubMed
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British Journal of General Practice: 55 (510)
British Journal of General Practice
Vol. 55, Issue 510
January 2005
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Nurse-led management of hypertension
Pippa Oakeshott, Sally Kerry, Sally Dean, Franco Cappuccio
British Journal of General Practice 2005; 55 (510): 53.

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Nurse-led management of hypertension
Pippa Oakeshott, Sally Kerry, Sally Dean, Franco Cappuccio
British Journal of General Practice 2005; 55 (510): 53.
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