Clinical Research Center, Hvidovre Hospital, 2650 Hvidovre, Denmark.
Department of Biostatistics, Lundbeck A/S, 2500 Valby, Denmark.
J Stroke Cerebrovasc Dis. 2011 Jan-Feb;20(1):16-23. doi: 10.1016/j.jstrokecerebrovasdis.2009.10.002. Epub 2010 Jun 17.
Lowering blood pressure (BP) in stroke survivors reduces the risk of recurrent stroke. We tested the hypothesis that a nurse-led nonpharmacologic intervention would lower the BP of participants in an intervention group compared with a control group. A total of 349 patients who had sustained acute stroke or transient ischemic attack were randomly assigned to either usual care or to 4 home visits by a nurse. During the visits, the nurse measured and recorded BP and provided individually tailored counseling on a healthy lifestyle. A total of 303 patients completed the 1-year follow up. No change in systolic BP was noted in either the intervention group or the control group. Because of an increase in diastolic BP in the control group (P = .03), a difference in mean diastolic BP between the 2 groups was found at follow-up (P = .007). Mean BP at follow-up was 139/82 mm Hg in the intervention group and 142/86 mm Hg in the control group. Linear regression analysis demonstrated that BP at the point of discharge was the strongest predictor of BP 1 year later (P < .0001). The proportion of patients on antihypertensive medication increased in the intervention group (P = .002). Patients were compliant with antihypertensive therapy, and 92% of the hypertensive patients in the intervention group followed the advice to see a general practitioner (GP) for BP checkups. At follow-up, 187 patients (62%) were hypertensive, with no difference in the rate of hypertension seen between the groups. Our data indicate that home visits by nurses did not result in a lowering of BP. Patients complied with antihypertensive therapy and GP visits in the case of hypertension. Nonetheless, the majority of patients were hypertensive at the 1-year follow up.
降低脑卒中幸存者的血压（BP）可降低再次发生脑卒中的风险。我们检验了一个假设，即护士主导的非药物干预会降低干预组患者的血压，与对照组相比。共有 349 名急性脑卒中或短暂性脑缺血发作的患者被随机分配到常规护理组或由护士进行 4 次家庭访问的干预组。在访问期间，护士测量并记录血压，并提供有关健康生活方式的个性化咨询。共有 303 名患者完成了 1 年的随访。干预组和对照组的收缩压均无变化。由于对照组舒张压升高（P =.03），随访时两组间平均舒张压存在差异（P =.007）。干预组的平均 BP 为 139/82mmHg，对照组为 142/86mmHg。线性回归分析表明，出院时的 BP 是 1 年后 BP 的最强预测因素（P<0.0001）。干预组接受降压药物治疗的患者比例增加（P=.002）。患者对降压治疗的依从性良好，干预组 92%的高血压患者按照建议去看全科医生（GP）进行血压检查。随访时，187 名患者（62%）患有高血压，两组间高血压的发生率无差异。我们的数据表明，护士家访并没有降低血压。如果高血压患者接受了降压治疗和 GP 随访，他们会遵守治疗。尽管如此，大多数患者在 1 年的随访中仍患有高血压。
