Vedanthan Rajesh, Kumar Anirudh, Kamano Jemima H, Chang Helena, Raymond Samantha, Too Kenneth, Tulienge Deborah, Wambui Charity, Bagiella Emilia, Fuster Valentin, Kimaiyo Sylvester
Department of Population Health, NYU Grossman School of Medicine, New York, US.
Department of Medicine, NYU Grossman School of Medicine, New York, US.
Glob Heart. 2020 Dec 1;15(1):77. doi: 10.5334/gh.856.
Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates remain very low. An expanding literature supports the strategy of task redistribution of hypertension care to nurses.
We aimed to evaluate the effect of a nurse-based hypertension management program in Kenya.
We conducted a retrospective data analysis of patients with hypertension who initiated nurse-based hypertension management care between January 1, 2011, and October 31, 2013. The primary outcome measure was change in systolic blood pressure (SBP) over one year, analyzed using piecewise linear mixed-effect models with a cut point at 3 months. The primary comparison of interest was care provided by nurses versus clinical officers. Secondary outcomes were change in diastolic blood pressure (DBP) over one year, and blood pressure control analyzed using a zero-inflated Poisson model.
The cohort consisted of 1051 adult patients (mean age 61 years; 65% women). SBP decreased significantly from baseline to three months (nurse-managed patients: slope -4.95 mmHg/month; clinical officer-managed patients: slope -5.28), with no significant difference between groups. DBP also significantly decreased from baseline to three months with no difference between provider groups. Retention in care at 12 months was 42%.
Nurse-managed hypertension care can significantly improve blood pressure. However, retention in care remains a challenge. If these results are reproduced in prospective trial settings with improvements in retention in care, this could be an effective strategy for hypertension care worldwide.
高血压是全球范围内导致死亡的首要原因；然而，其治疗率和控制率仍然很低。越来越多的文献支持将高血压护理任务重新分配给护士的策略。
我们旨在评估肯尼亚一项以护士为基础的高血压管理项目的效果。
我们对2011年1月1日至2013年10月31日期间开始接受以护士为基础的高血压管理护理的高血压患者进行了回顾性数据分析。主要结局指标是一年内心脏收缩压（SBP）的变化，使用分段线性混合效应模型进行分析，切点为3个月。主要的感兴趣比较是护士提供的护理与临床医生提供的护理。次要结局是一年内心脏舒张压（DBP）的变化，以及使用零膨胀泊松模型分析的血压控制情况。
该队列包括1051名成年患者（平均年龄61岁；65%为女性）。从基线到三个月，SBP显著下降（护士管理的患者：斜率为-4.95 mmHg/月；临床医生管理的患者：斜率为-5.28），两组之间无显著差异。从基线到三个月，DBP也显著下降，不同提供者组之间无差异。12个月时的护理留存率为42%。
以护士为基础的高血压护理可以显著改善血压。然而，护理留存率仍然是一个挑战。如果这些结果在前瞻性试验环境中得到重现，且护理留存率有所提高，那么这可能成为全球高血压护理的有效策略。
