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Background and Research Objective: Nurses play an important role in hypertension prevention and management because of their unique positions in patient education. However, the effectiveness of patient education relies largely on the nurse's level of awareness of the current hypertension guidelines. The purpose of this study was to examine the level of awareness of hypertension guidelines and associated factors among nurses in Taiwan., Subjects and Methods: A cross-sectional survey was conducted in 10 hospitals in northern Taiwan. The Hypertension Management Questionnaire was developed based on the Taiwan Hypertension Guidelines and the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure., Results: The survey return rate was 95.9%. A total of 1418 nurses were included in the analysis. Adequate guideline awareness was found in 49.5% of the total sample. Among the 7 dimensions of the Hypertension Management Questionnaire, the definition of hypertension, methods for blood pressure measurements, and impact of high blood pressure on cardiovascular disease had the lowest rates of correct answers. Multiple regression analysis revealed that the nurses' clinical experience, educational level, work setting, in-service education training on hypertension, and level of the hospital (R2 = 35.4%, F = 52.89, P < .001) independently predicted the nurse's level of awareness., Conclusions: A large proportion of the nurses in northern Taiwan had insufficient knowledge of the hypertension guidelines.

Background: Previous reviews demonstrate uncertainty about the effectiveness of nurse-led interventions in the management of hypertension. No specific reviews in diabetes have been identified. We have systematically reviewed the evidence for effectiveness of nurse-led interventions for people with diabetes mellitus., Methods: In this systematic review and meta-analysis, searches of Medline, Embase, CINAHL and the Cochrane Central Trials register were undertaken to identify studies comparing any intervention conducted by nurses in managing hypertension in diabetes with usual doctor-led care. Additional citations were identified from papers retrieved and correspondence with authors. Outcome measures were absolute systolic and diastolic blood pressure, change in blood pressure, proportions achieving study target blood pressure and proportions prescribed anti-hypertensive medication., Results:   Eleven studies were identified. Interventions included adoption of treatment algorithms, nurse-led clinics and nurse prescribing. Meta-analysis showed greater reductions in blood pressure in favour of any nurse-led interventions (systolic weighted mean difference -5.8 mmHg, 95% CI -9.6 to -2.0; diastolic weighted mean difference -4.2 mmHg, 95% CI -7.6 to -0.7) compared with usual doctor-led care. No overall superiority in achievement of study targets or in the use of medication was evident for any nurse-based interventions over doctor-led care., Conclusions: There is some evidence for improved blood pressure outcomes with nurse-led interventions for hypertension in people with diabetes compared with doctor-led care. Nurse-based interventions require an algorithm to structure care and there is some preliminary evidence for better outcomes with nurse prescribing. Further work is needed to elucidate which nurse-led interventions are most effective., (© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.)

Background: Hypertension, one of the increasingly common chronic diseases, is reported to be an important factor in the formation of sexual dysfunction (SD) due to the physiopathological changes it creates in the vascular endothelial structure. The evaluation of the sexual functions of hypertensive women is regarded as a significant consideration in the improvement of women's health and quality of life., Aim: This study was carried out in order to identify the sexual functions of essential hypertensive women., Methods: The study was an experimental design. 71 essential hypertensive women with no other chronic disease formed the experimental group, whereas randomly selected 85 healthy married women who hadn't had menopause and didn't have any known chronic disease formed the control group. The research data were collected by "Personal Information Forms I-II", and "Female Sexual Function Index"., Results: In the study hypertensive women's overall mean score of FSFI was found to be significantly lower than that of healthy women's (p<0.001). 90% of hypertensive women and 41% of healthy women were found to have SD. It was determined that in the women constituting both groups, age increase raises SD occurrence frequency; however, with the increase in education and income level sexual life related problems decrease. It was also determined that increase in body mass index and duration of disorder raise SD occurrence frequency in women., Conclusion: It was concluded that sexual dysfunction is observed in hypertensive women more frequently than healthy women and that essential hypertension affects female sexual functions significantly., (Copyright © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.)

Objectives: To verify the reproducibility of defining the characteristics and related factors in order to identify a sedentary lifestyle in patients with high blood pressure., Design and Sample: A cross-sectional study. 310 patients diagnosed with high blood pressure., Measures: Socio-demographics and variables related to defining the characteristics and related factors of a sedentary lifestyle. The coefficient Kappa was utilized to analyze the reproducibility. The sensitivity, specificity, and predictive value of the defining characteristics were also analyzed. Logistic regression was applied in the analysis of possible predictors., Results: The defining characteristic with the greatest sensitivity was demonstrates physical deconditioning (98.92%). The characteristics chooses a daily routine lacking physical exercise and verbalizes preference for activities low in physical activity presented higher values of specificity (99.21% and 95.97%, respectively)., Conclusions: The following indicators were identified as powerful predictors (85.2%) for the identification of a sedentary lifestyle: demonstrates physical deconditioning, verbalizes preference for activities low in physical activity, and lack of training for accomplishment of physical exercise., (© 2010 Wiley Periodicals, Inc.)

Objective: To assess blood pressure (BP) control among patients with hypertension managed by nurse practitioners (NPs) vs physicians., Study Design: Cross-sectional study., Methods: Retrospective medical record reviews were conducted at 3 independent NP-based practices and at 21 physician-based practices. Investigators at each practice identified a sample of patients 18 years or older with a hypertension diagnosis. The primary outcome was controlled BP (<140/90 mm Hg for patients without diabetes mellitus and <130/80 mm Hg for patients with diabetes mellitus). Propensity score matching was used to minimize potential selection bias between NP-treated and physician-treated patients and to balance differences in patient characteristics. Logistic regression analysis was performed to estimate the odds of controlled BP for NP-treated vs physician-treated patients, adjusting for covariates., Results: The NP-treated sample was composed of 684 patients; their mean age was 54.2 years, 62.6% were female, 59.7% were obese, and 19.2% had diabetes mellitus. Before propensity score matching, physician-treated patients were older, less likely to be female, and more likely to have diabetes. The propensity score-matched cohort (n = 623 in each group) had similar baseline characteristics. Among the NP cohort, 70.5% had controlled BP compared with 63.2% among the physician cohort; the mean number of antihypertensive medications was lower among NP-treated patients (1.6 vs 1.8, P = .01). The adjusted odds of controlled BP were slightly lower for physician-treated patients (odds ratio, 0.76; 95% confidence interval, 0.58-0.99)., Conclusions: Comparable controlled BP rates were observed among patients with hypertension receiving care from an NP vs a comparison group receiving care from a physician; the groups had similar baseline characteristics. Our findings support the increasingly important role of NPs in primary care.

Objectives: To evaluate the efficacy of a healthcare education program for patients with hypertension., Methods: A multicenter, prospective, cluster-randomized trial was conducted. Randomization was by primary care center; 18 of 36 urban primary care centers in Barcelona and its metropolitan area were randomized to the intervention group (IG) and 18 to the control group (CG). The study sample consisted of patients with hypertension (n=996; 515 in the IG and 481 in the CG) receiving outpatient treatment with antihypertensive drugs. The intervention consisted of personalized information by a trained nurse and written leaflets. Questionnaires on knowledge and awareness of hypertension and its medication, treatment adherence, healthy lifestyle habits, systolic and diastolic blood pressure, and body mass index were assessed at each visit, with a 12-month follow-up. An intention-to-treat analysis was applied., Results: Knowledge of hypertension increased by 27.8% in the IG and by 18.5% in the CG, while that of medication increased by 10.1% in the IG and 5.5% in the CG. Treatment adherence measured by the Morisky-Green test increased by 9.6% (95% CI: 5.5-13.6) in the IG and 8.8% (95% CI: 4.9-12.6) in the CG. There were no differences in adherence on the other tests used. No differences were observed between the IG and CG in clinical variables such as blood pressure or BMI at the end of the trial., Conclusions: The educational intervention had no significant impact on patients' adherence to the medication., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals: a condition labelled as 'uncontrolled' hypertension. The optimal way to organise and deliver care to hypertensive patients has not been clearly identified., Aim: To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension., Design of Study: Systematic review of randomised controlled trials., Setting: Primary and ambulatory care., Method: Interventions were categorised as following: self-monitoring; educational interventions directed to the patient; educational interventions directed to the health professional; health professional- (nurse or pharmacist) led care; organisational interventions that aimed to improve the delivery of care; and appointment reminder systems. Outcomes assessed were mean systolic and diastolic blood pressure, control of blood pressure and proportion of patients followed up at clinic., Results: Seventy-two RCTs met the inclusion criteria. The trials showed a wide variety of methodological quality. Self-monitoring was associated with net reductions in systolic blood pressure (weighted mean difference [WMD] -2.5 mmHg, 95%CI = -3.7 to -1.3 mmHg) and diastolic blood pressure (WMD -1.8 mmHg, 95%CI = -2.4 to -1.2 mmHg). An organised system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure and all-cause mortality in a single large randomised controlled trial., Conclusion: Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. Self-monitoring is a useful adjunct to care while reminder systems and nurse/pharmacist -led care require further evaluation.

Background: The prevalence of hypertension is high, but the overall control rate is low. Poor control of, hypertension is associated with a number of diseases, such as stroke, heart and renal failure, and high, mortality rates. Studies have shown the separate effects of nurse clinics and telephone follow-up on, blood pressure control, but the incremental effect of combining the two interventions is unknown., Objectives: This study examines whether there is an incremental effect on blood pressure control when using a nurse clinic combined with telephone follow-up., Methods: This was a randomised controlled trial. The primary outcome measure was blood pressure reading. The secondary outcome measures included adherence to home blood pressure monitoring, exercise, diet, medication, and satisfaction with care., Results: There were no significant differences in the baseline measures between the control and study groups. Significant differences were found at 8 weeks after intervention was initiated between groups in, systolic blood pressure (control -7.97 vs study -19.03, t=2.35, p=0.022, CI 1.66-20.47) and diastolic, blood pressure (control -3.72 vs study -11.68, t=3.02, p=0.004, CI 2.68-13.24). Other variables with a significant between-group differences (p<0.05) were blood pressure control rate, adherence, to home blood pressure monitoring, exercise and satisfaction with care. Further analysis using, regression showed that home blood pressure monitoring is the most significant predictor for improved, systolic blood pressure., Conclusions: This study showed that nurse clinics have positive effects on blood pressure control and adherence to healthy lifestyle, but telephone follow-up after such clinics augments the effects of the clinic consultation. This combined mode of services is worth considering for other chronic disease, management programmes., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: Our study describes the services faith-community nurses provide to a community-dwelling sample of patients with elevated blood pressure., Design and Sample: The faith-community nurses completed a survey describing services provided to study participants at each patient encounter. We describe the type of contact and the frequency and types of services provided to these patients. From October 2006 to October 2007, we conducted a partnered study with a faith-community nursing program and enrolled 100 adults with elevated blood pressure from church health fairs., Measures: Patient demographics and faith-community nurse services provided., Results: Data from 63 of 108 (58%) visits to faith-community nurses made by 33 participants were collected from surveys completed by the nurses. The majority of the participants were female (64%), Latino (61%), with an average age of 59 (SD=11) years and incomes below US$30,000 (83%). The most frequent services patients received from faith-community nurses were blood pressure measurement (73%), hypertension-specific education on dietary changes (67%), and supportive counseling (56%)., Conclusions: Faith-community nurses represent a new method of supportive self-management for low-income individuals with a chronic condition who may otherwise have limited access to health services. Further research is needed to understand the effect of faith-community nurse interventions on improving chronic disease health outcomes in these communities., (© 2010 Wiley Periodicals, Inc.)

Background and Objectives: Older adults' adherence to antihypertensive medications is far lower than what is considered necessary for clinical effectiveness, despite the risks for adverse cardiovascular events from uncontrolled blood pressure (BP) in the elderly. This pilot study tested a novel 8-week behavioral feedback intervention to improve antihypertensive medication adherence (MA) and BP control among older adults on existing treatment for hypertension., Methods: Adults 60 years old, or older taking at least 1 antihypertensive medication were randomized to receive the nurse-delivered adherence intervention or usual care. Medication adherence was monitored continuously using electronic monitoring for 20 weeks. Intervention-group participants received biweekly MA and BP feedback, habit counseling, medication and disease education, a medication instruction card, and were given an electronic medication bottle cap with a digital display that provided daily adherence feedback during the 8-week intervention. Blood pressure was measured by a nurse at 12 and 20 weeks after randomization. Adherence and BP outcomes were described using descriptive statistics and analyzed for between- and within-group differences using Mann-Whitney U tests., Results: Fifteen participants (median age, 71 years; 73% female) were eligible for randomization. Participants took an average of 5.8 prescription medications and 2.93 over-the-counter medications per day. A nonsignificant difference was noted in baseline MA between groups. At the end of the intervention, the treatment group had better antihypertensive MA than did the control group (median MA: 100% vs 27.3%, U = 5.00, P = .013). Systolic BP improved slightly in the intervention group during the study and was significantly different at week 12 (median systolic BP: 130 vs 152 mm Hg; U = 4.50, P = .008). Diastolic BP was largely unchanged over the course of the study., Conclusion: The results indicate that the intervention had a positive effect on MA. Additional testing is needed to further evaluate the intervention and its effect on adherence behavior and BP control.

Aim: This paper is a report of a study of the extent to which demographic characteristics, medication-related factors, hypertension-related knowledge and medication adherence predict systolic and diastolic blood pressure., Background: Little is known about predictors of hypertension control in Chinese elders., Methods: A longitudinal study with a 3-month follow-up was conducted with 90 Chinese immigrants to the United States of America aged ≥65 years and recruited from 2006 to 2007. The independent variables were measured at baseline. Blood pressure was measured at 3 months. Multiple linear regression analysis was used to evaluate the independent effects of seven variables on change in blood pressure at 3 months., Results: Participants ranged in age from 66 to 92 years (Mean 76.7, sd 6.6). The overall regression model for systolic blood pressure was statistically significant (R² = 0.32, F = 4.37, P < 0.01). A higher number of prescribed oral medications (sr² = 0.06, t = 2.42, P = 0.02) and lower medication adherence (sr² = 0.07, t = -2.60, P = 0.01) were statistically significant determinants of an increased systolic blood pressure. The overall regression model for diastolic blood pressure was statistically significant (R² = 0.21, F = 2.39, P = 0.03). Male gender (sr² = 0.06, t = 2.26, P = 0.03) and lower medication adherence (sr² = 0.11, t = -3.03, P < 0.01) were statistically significant determinants of an increased diastolic blood pressure., Conclusion: A greater number of prescribed medications and lower adherence predicted higher level of systolic blood pressure. Male gender and lower adherence were significantly associated with higher level of diastolic blood pressure. These predictors should be considered when designing interventions to help Chinese elders achieve better hypertension management., (© 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.)

Clinical practice varies regarding the choice of agent to treat hypertensive emergencies. With the development of national guidelines, a standardized pharmacotherapeutic approach would be recommended on the basis of evidence in the published literature. Such an approach might decrease the variability among practitioners and institutions in the treatment of hypertensive emergencies. Each available agent to treat hypertensive emergencies possesses both positive and negative attributes. With several intravenous, short-acting, agents available, clinicians must make educated decisions about the best medication for their patients, and these decisions should be based on organ function as well as the patient's clinical presentation. The primary goal in hypertensive emergencies is to rapidly and safely reduce blood pressure to prevent further end-organ damage. Critical care nurses have an important role in the safe and effective management of these patients. The application of knowledge of treatment goals, hemodynamic monitoring, and pharmacological therapy for hypertensive emergencies can lead to the safe recovery of these critically ill patients.

Aims and Objectives: The main goal of nursing care should be to increase health-related quality of life as well as improve the medical status of patients with chronic disease. For this reason, this study aims to evaluate and compare the health-related quality of life of patients with diabetes mellitus, hypertension and obesity in Gaziantep, a south-eastern city in Turkey., Background: Diabetes mellitus, hypertension and obesity are the most decisive factors in terms of adversely affecting health-related quality of life., Design: A cross-sectional, descriptive design was used., Method: In this study, the research population included a total of 1601 diabetes mellitus, hypertension and obesity patients. To evaluate health-related quality of life of patients, Short Form-36 (SF-36) was used. Student's t-test, one-way anova and chi-square analyses were used for comparisons between groups., Results: In total, 18·1% of patients had combined obesity, hypertension and diabetes mellitus; 16·1% had hypertension and diabetes mellitus. Approximately 16·1% had only hypertension; 15·4% had obesity and hypertension; 13·3% had diabetes mellitus; 12·7% had obesity and diabetes mellitus; and 8·4% had obesity. The health-related quality of life physical component mean scores of patients with combined obesity and hypertension were lower than that of the other groups (p < 0·05). Health-related quality of life physical component mean scores were determined as 34·5 (SD 0·4), and mental component mean scores were determined as 43·9 (SD 4·4). Health-related quality of life physical component mean scores of moderately active patients were higher, while older age and lower educational and income levels had a negative effect on health-related quality of life (p < 0·05)., Conclusion: Diabetes, hypertension and obesity decrease patient health-related quality of life while physical activity increases it. The coexistence of obesity and hypertension, in particular, has a more negative effect on health-related quality of life., Relevance to Clinical Practice: Patients with hypertension, obesity and diabetes mellitus need professional support from nurse. Frequent health-related quality of life evaluation and support is required for chronic patients, especially for those who are older, have lower educational and income levels and those with more than one chronic disease., (© 2010 Blackwell Publishing Ltd.)

Objective: To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study., Design: Systematic review and meta-analysis., Data Sources: Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database., Study Selection: Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults., Data Extraction: Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken., Data Synthesis: Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5)., Conclusions: Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.

Aims: The primary aim was to assess long-term blood pressure in 110 patients with Type 2 diabetes who had achieved optimal blood pressure control during attendance at a protocol-based nurse-led hypertension intensive intervention clinic 7 years previously. The secondary aim was to assess modifiable cardiovascular risk factor status., Methods: One hundred and ten patients who attended the clinic during 2000-2002 were selected to reattend to have their blood pressure measured to the same standard as it was during the intensive intervention clinic, by the same specialist nurse. Treatment details were recorded., Results: Of the 110 patients, 36 (33%) had died; 69 (63%) of the remaining 74 patients were eligible to be contacted by letter; and 35 (51%) agreed to reattend. Age was 70 +/- 9 years; 21 (60%) were male; and the duration of diabetes was 17 +/- 7 years. Compared with 7 years previously, there was no difference in blood pressure control (systolic 130 +/- 17 vs. 131 +/- 16 mmHg, P = 0.62; diastolic 68 +/- 9 vs. 65 +/- 9 mmHg, P = 0.11). The number of patients with blood pressure <130/80 mmHg remained the same: 17 (49%) vs. 17 (49%; P > 0.99). During the 7 year period, 14 (40%) vs. 20 (57%) had macrovascular disease (P = 0.23), and 14 (40%) vs. 19 (54%) microvascular disease (P = 0.33). Thirteen (37%) vs. 18 (51%) were taking three or more antihypertensive drugs (P = 0.33), and 26 (74%) vs. 28 (80%) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (P = 0.77)., Conclusions: Optimal blood pressure control was sustained with no significant changes to antihypertensive medication, demonstrating the effectiveness of a protocol-based nurse-led clinic in achieving strict BP control.

Hypertension is one of the main risk factors for cardiovascular diseases. Nursing carries a large responsibility in care delivery to hypertensive individuals. Thus, the goal was to assess a nursing team's knowledge on hypertension and its treatment before and after educational interventions. A questionnaire was used, addressing theoretical aspects of hypertension knowledge among nurses (5), technicians (2), auxiliaries (11) and community agents (37) at two Basic Health Units in São Paulo City, Brazil. For statistical analysis, Student's T test was used, as well as variance analysis and p < 0.05. A knowledge increase was verified after the educational interventions for the group constituted by nurses, technicians and nursing auxiliaries (84.6 +/- 12.0% vs. 92.7 +/- 15.0%, p < 0.05), while no significant change occurred for community health agents (80.8 +/- 12.2% vs. 83.5 +/- 24.0%). Thus, it was concluded that the educational actions were effective and must be put in practice in the nursing team, which they can influence the improvement of care delivery for hypertensive patients.

Aims: This manuscript presents results from 4 years experience in a nurse-led hypertension clinic. The aim of the hypertension clinic was to optimize hypertension treatment and to reduce the number of physician consultations., Materials and Methods: All patients were initially examined by cardiologists. All follow-up visits were performed by nurses. They initiated and titrated antihypertensive medication according to a stepwise treatment algorithm or the physicians' instructions. The blood pressure (BP) measurement technique and the recording of risk profile were performed as instructed by guidelines from the European Hypertension Society., Results: During the first 4 years, 186 patients were treated in the hypertension clinic. One hundred and thirty patients were treated by the nurses alone and hereafter discharged to general practitioners; 95% of these patients reached target BP. Most of the patients received combination therapy with two to seven different antihypertensive drugs. The three primary antihypertensive drugs (calcium-channel blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics) were the first drugs to be used and they made up the main part of the combination therapy., Conclusion: In spite of many risk factors, co-existing cardiovascular diseases and severe hypertension, 95% of the patients achieved target BP when treated in a nurse-led hypertension clinic. We suggest that the data serves as an inspiration for other clinics and GPs to implement the concept.

Background: Self-management can improve health behaviors and influence reduction of vascular risk. We developed a 1-year self-management intervention and investigated its effect on vascular risk factors and quality of life in patients with different vascular diseases., Design and Methods: This observational cohort study involved 223 patients (self-management group, n=125; usual care group n=98) with at least two modifiable vascular risk factors., Results: Patients in the self-management group achieved treatment goals for LDL-cholesterol (difference 13%; 95%CI 1-26) and HDL-cholesterol (difference 9% 95%CI 0-19) significantly more often than did patients in the usual care group. Mean systolic blood pressure decreased significantly by 5mm Hg (95%CI -9 to 0) in the self-management group and mean BMI increased significantly by 0.4 kg/m(2) (95%CI -0.8 to -0.1) in the usual care group. No significant differences were seen in waist circumference, smoking, or triglycerides. General health (RAND36) improved more in the self-management group (by 8 points 95%CI 3-12) than in the usual care group., Conclusion: After 1 year, the self-management intervention was more effective than usual care on several important vascular risk factors in patients with vascular diseases., Practice Implications: This self-management intervention used in a hospital population may be applicable in different care settings., (Copyright (c) 2009 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.)

Objectives: The objectives of this study are to evaluate the effectiveness of Chinese food therapy in correcting the Yin-deficiency and to examine its impact on the patients' quality of life and hypertension control., Background: Epidemiological studies have shown 14-50% of people with hypertension have Yin-deficiency. Whether restoring the Yin-Yang balance by means of Chinese food therapy can help to better manage patients with hypertension has yet to be examined., Design: Two groups randomised controlled trial., Methods: Eighty-five hypertensive patients recruited from two community health service centre were divided into two groups. The intervention group (n = 48) received specific dietary instructions and corresponding management of their antihypertensive medication if indicated and brief health education, whilst the control group (n = 37) received routine support involving only brief health education. Data were collected at baseline, after intervention at four, eight, 12 and 16 weeks follow-up. Comparisons were made to examine the effects of Chinese food therapy on Yin-deficiency symptoms, blood pressure and quality of life of hypertensive patients., Results: The intervention group had reduction in the numbers of antihypertensive medication taken as well as improvement in most of the Yin-deficiency symptoms after 12 weeks of Chinese food therapy and mean scores of several SF-36 dimensions were higher than that of in the control group after 12 and 16 weeks follow-up. Significant difference was found in systolic blood pressure in the intervention group when it was compared from baseline to after four and eight weeks respectively., Conclusion: Chinese Food Therapy can restore body constitution with Yin-Yang imbalance and may potentially improve hypertensive patients' quality of life. It is also beneficial in controlling blood pressure in hypertensive patients., Relevance to Clinical Practice: Chinese food therapy may become a complementary therapy in health care and it should be a component of nursing education and health education.

Aims and Objectives: (1) To explore the effect of continued nursing intervention on hypertensive patients based on chronotherapeutics. (2) To identify the factors affecting hypertensive patients' compliance to the chronotherapeutics-oriented nursing interventions., Background: Chronotherapy provides a means of individual treatment for hypertension according to the circadian blood-pressure profile of each patient and constitutes a new option in optimising blood-pressure control and reducing risk from hypertension., Design: Experimental study., Methods: All participants enrolled were randomly divided into the intervention group and the control group and they all took antihypertensive medicine prescribed by their doctors under ambulatory blood pressure monitoring. According to individual ambulatory blood pressure monitoring measures, interventions were implemented., Results: (1) There were significant differences in blood pressure and compliance to chronotherapeutics between the two groups before and after the intervention. (2) Single variant and multiple factors analysis revealed different characteristics influencing chronotherapeutic compliance of hypertensive patients., Conclusions: Under ambulatory blood pressure monitoring, continued nursing intervention for hypertensive patients guided by chronotherapeutics could effectively improve blood-pressure control and chronotherapeutic compliance., Relevance to Clinical Practice: Health care providers who deal with Chinese hypertensive patients can improve patients' therapeutic compliance and blood pressure control guided by chronotherapeutics. According to different influencing factors on patients' chronotherapeutic compliance nurses should pay more attention to those whose compliance might be worse.

Introduction: A recent Cochrane report concluded that an effective system for hypertension control has yet to be identified. This manuscript presents results from four years' work in a nurse-guided hypertension clinic. The aim of the hypertension clinic was to reduce the number of physician-consultations and to optimize hypertension treatment., Material and Methods: All patients were initially examined by physicians. All follow-up visits were performed by the nurses of the hypertension clinic. They initiated and titrated antihypertensive medication according to a treatment algorithm or the physicians' instructions. Blood pressure (BP) measurement and recording of risk profile were performed in accordance with guidelines from the Danish Hypertension Association., Results: During the four years, 186 patients were treated at the Hypertension Clinic. A total of 130 were discharged to general practice. 95% of these reached their target BP. In all, 56 patients continued treatment at cardiological or nephrological out-patient clinics, or preferred to stop their treatment at the hypertension clinic and refused further referral. Most of the patients received combination therapy with 2-7 different antihypertensive drugs. The three primary antihypertensive drugs were the three first drugs to be used and they comprised the majority of the combination therapy. Many patients received betablockers either as an antihypertensive drug or because of ischemic heart disease., Conclusion: Despite many risk factors and severe hypertension, 95% of the patients achieved their target BP. We hope the results will inspire physicians and GP's to adapt the concept.

Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus.

This article provides an overview of the blood pressure (BP) in elderly, how it is assessed and its management. It explains the need of multiple BP measurements as well as the standing measurement and use of ambulatory blood pressure monitoring for assessing blood pressure in elderly. Some years ago elderly people were seen as a different group of population who needed to be managed differently for BP and this view is now changed. The management can be pharmacological or non-pharmacological, which includes weight reduction, salt reduction, reducing alcohol consumption, carrying out regular exercise and physical activity, healthy diet and smoking cessation. This article explains on how the anti-hypertensive medication should be started on an elderly patient and what measures should be taken while they are on this medication.

Objectives: To evaluate the effectiveness of involving primary care nurses in comprehensive care of patients with hypertension and diabetes mellitus type II (DM2)., Methods: A quasi-experimental, before-and-after study was conducted, without a control group, in eight family-practice clinics. Trained nurses offered comprehensive care in conjunction with a team made up of a family doctor, a nutritionist, a social worker, and a dentist. The intervention lasted seven months and its outcome variables were changes in body mass index, fasting blood glucose, blood pressure, self-perceived health status, treatment compliance, and emergency services requests. Any change was determined by comparing the baseline to the final measurement through interviews and recording the variables of interest in a spreadsheet., Results: In all, 1 131 patients completed the follow-up, of which 44.9% were diagnosed with hypertension, 27% with DM2, and 28.1% with both conditions. The proportion of patients seen by the coordinated health teams increased; there was a rise in cases of normal weight and overweight; a decrease in the proportion of obese (P < 0.05); and an increase in hypertensives with high blood pressure (< 130/ 80mmHg) (P < 0.05). There was no change in the proportion of diabetics with high blood glucose (< 140 mg/dl); 18.2% reported improved self-perceived health status (P < 0.05); there was improved treatment compliance (P < 0.05); and a decrease in requests for emergency services at the clinics (-4.5%) and at the hospitals (-6.8%) (P < 0.05)., Conclusions: Comprehensive care for chronically ill patients through the involvement of nurses contributes to improved health outcomes in primary care.

Background: Nurses in hypertension care play an important role in minimising the risk factors for cardiovascular diseases, but this care can be improved., Aim: To evaluate the content of nurses' consultations with hypertensive patients before and after consultation training., Methods: Nineteen nurses from a randomised study of nurse-led hypertension clinics at health centres received three days of residential training in patient-centred counselling and cardiovascular prevention. To assess the result, two consultations with hypertensive patients in clinical practice before and after the training were audio-recorded. Content analysis was used for the analysis., Results: Diet and exercise were the most frequent topics in the consultations both before and after the training. Discussions about alcohol and the patient's responsibility for treatment increased after the training. The time spent talking about various issues, other health problems, history and appointment scheduling decreased in the consultations after the training., Conclusion: After the consultation training, the nurses succeeded in emphasising important issues for risk factor control to a greater extent.

For consumer health informatics (CHI) interventions to successfully aid laypeople, the interventions must fit and support their health work. This paper outlines a scenario-based human factors assessment of a disease management CHI intervention. Two student users undertook a patient use case and another user followed a nurse use case. Each user completed pre-specified tasks over a ten-day trial, recorded challenges encountered while utilizing the intervention, and logged daily time spent on each task. Results show the scenario-based user testing approach helps effectively and systematically assess potential physical, cognitive, and macroergonomic challenges for end-users, rate the severity of the challenges, and identify mediation strategies for each challenge. In particular, scenario-based user testing aids in identifying challenges that would be difficult, if not impossible, to detect in a laboratory-based usability study. With this information, CHI interventions can be re-designed and/or supplemented, making the intervention more closely fit end-users' work.

Purpose: To educate advance practice nurses on the diagnosis, pharmacologic, and nonpharmacologic management of hypertension in children and adolescents., Data Sources: Information was collected through a search of published literature and clinical practice guidelines., Conclusions: Increasing rates of hypertension in children and adolescents are correlated to risk for coronary artery disease in adulthood. Nonpharmacologic management includes lifestyle modifications addressing weight reduction, physical activity, and dietary modification. Pharmacologic management is typically reserved for patients with severe hypertension or those who do not respond to lifestyle modifications. Early intervention is critical for preventing target-organ damage and complications of long-term hypertension., Implications for Practice: Nurse practitioners must identify and address elevated blood pressure levels in children and adolescents. Many children and adolescents can successfully lower blood pressure readings through nonpharmacologic lifestyle changes. Education about lifestyle modification strategies should focus on family-based changes in order to increase likelihood of successful implementation.

Hypertension is an important contributor to the risk of cardiovascular disease and death, yet success in achieving blood pressure (BP) control has been limited. Most patients will require 2 or more medications to control their BP. Nurse practitioners play a vital role in treating patients with hypertension and can help overcome barriers to reaching BP goals. Measures to improve therapeutic adherence include educating the patient and simplifying the medication regimen. Use of single-pill combination therapy, which reduces the pill burden, can contribute to improved medication persistence and compliance. Rational combination therapy combines medications with complementary mechanisms of action, such as a calcium channel blocker (CCB) and a renin-angiotensin-aldosterone system (RAAS) inhibitor; it is often more efficacious than monotherapy and allows the use of lower doses of the individual components, which usually results in improved tolerability. Current guidelines support the first-line use of combination therapy in many patients. Initiating therapy with a RAAS inhibitor-based combination can reduce BP and cardiovascular risk and may be more effective for some patients than traditional combinations such as a beta-blocker with a diuretic. Adverse events associated with any medication can compromise its therapeutic usefulness. Peripheral edema is a common and dose-dependent adverse event seen with dihydropyridine CCBs, which can cause marked patient distress, reduce adherence to therapy, and result in dose reduction or even discontinuation of therapy. In most cases, CCB-induced peripheral edema can be managed successfully, and CCB therapy need not be abandoned. Management strategies include nonpharmacologic and pharmacologic measures. Several clinical trials have shown a lower incidence of peripheral edema in patients receiving combination therapy with a CCB and a RAAS blocker compared with CCB monotherapy.

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in an enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors, such as obesity, can be controlled, others, for example genetics, are more difficult to treat because often there is more than one factor involved. This article explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. Nurse-led clinics are more cost-effective, staff are more productive and clients are more compliant with treatment.

Background: Despite a lot of study related to medication adherence in hypertension, a major problem in research is the measurement of adherence., Aim: To evaluate the reliability and validity of the Turkish version of the Medication Adherence Self-Efficacy Scale (MASES) among hypertensive patients in an outpatient setting in Turkey., Methods: One hundred-forty adult patients, who are receiving medication for hypertension in the last one year, were included to study sample. MASES was translated using a back-translation technique, which includes the use of a panel of experts and interpreters to translate the items from the source language to the target language and then back-translate them to the source language. Psychometric evaluations of MASES-Turkish form were used construct validity; item analysis, principal component analysis and known group validity and internal consistency reliability (Chronbach's alpha), Results: Reliability coefficient of the Turkish adaptation of MASES was found 0.92, and item-total correlations ranged between 0.26 and 0.72. It was found that factor structure of the MASES-Turkish consisted with original instrument. Patients with uncontrolled hypertension had lower self-efficacy scores compared to those with normal blood pressure.

Efforts to increase blood pressure (BP) control rates in blacks, a traditionally underserved high-risk population must address both provider practice and patient adherence issues. The home-based BP Intervention for blacks study is a 3-arm randomized controlled trial designed to test 2 strategies to improve hypertension management and outcomes in a decentralized service setting serving a vulnerable and complex home care population. The primary study outcomes are systolic BP, diastolic BP, and BP control; secondary outcomes are nurse adherence to hypertension management recommendations and patient adherence to medication, healthy diet, and other self-management strategies. Nurses (n=312) in a nonprofit Medicare-certified home health agency are randomized along with their eligible hypertensive patients (n=845). The 2 interventions being tested are (1) a "basic" intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional postacute home health care; and (2) an "augmented" intervention that includes that same as the basic intervention, plus transition to an ongoing Hypertension Home Support Program that extends support for 12 months. Outcomes are measured at 3 and 12 months after baseline interview. The interventions will be assessed relative to usual care and to each other. Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact. Results from this trial will provide important information on potential strategies to improve BP control in a low-income chronically ill patient population.

Purpose: This study aims to examine known determinants of cardiovascular risk in Italian patients with functional psychoses., Design and Methods: A cross-sectional study design was used to examine cardiovascular risk factors and lifestyle behaviors of 123 individuals with functional psychosis and compare clinically relevant data with those of the general Italian population., Findings: A significant proportion of patients manifested frank hypertension (6.9%), hypercholesterolemia (20.5%), diabetes (6.5%), or a body mass index of more than 30 (20.3%). Many also smoked (63.0%) or ingested alcohol every day (26.0%), did not eat fruits or vegetables (8.0%), or did not exercise on a daily basis (34.0%)., Practice Implications: Patients with psychosis manifest significant rates of potentially reversible risk factors for cardiovascular diseases. Mental health nurses should advocate for and implement well-resourced counseling programs to reduce the prevalence of smoking and metabolic syndrome in mental health populations.

Purpose: To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support., Data Sources: Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role., Conclusions: NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design., Implications for Practice: With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges.

This is a descriptive and exploratory study carried out in two teams of Family Health, in the municipality of Presidente Venceslau, São Paulo, Brazil, in order to characterize the profile of the elderly hypertensive patients who do not attend activities at the Hiperdia. Moreover, the study also aimed at identifying possible factors that interfere in the access to this program and the families' participation in the treatment as well. Data were collected in June 2007, with 36 elderly people through a semi-structured interview. It was observed that the prevalence of non-membership of the elderly to the program is 8.5%; elderly and families ignore information on the disease, and if there is no dependence, the family is not involved with the treatment. It was concluded that it is necessary to develop strategies to the elderly assistance so that there is an effective communication team-elderly-family Developing staff training to develop actions of health education is another need.

Purpose: To review the clinical benefits of inhibiting the renin-angiotensin system (RAS) through blood pressure (BP)-lowering and BP-independent mechanisms and to identify the benefits and potential limitations of RAS-blocking agents in various patient populations., Data Sources: PubMed search using the key terms renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, aliskiren, heart failure, diabetes, and nephropathy. Current published guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, American Diabetes Association, and National Kidney Foundation were reviewed., Conclusion: Antihypertensive treatment with an agent that inhibits the RAS effectively lowers BP in a broad range of patients. Whether these agents improve clinical outcomes is the subject of ongoing investigation. Results of recent trials suggest that for patients with or at risk of high-risk conditions, such as heart failure or diabetes, risk reduction with RAS-blocking agents may be independent of BP reduction. Inhibition of the RAS may also reduce risk of renal impairment., Implications for Practice: RAS-blocking agents are important in a variety of patient populations at high cardiovascular risk, but while angiotensin-converting enzyme inhibitors have proven benefits in some cases, angiotensin receptor blockers may be preferred in others. Direct renin inhibitors are currently being evaluated. The nurse practitioner should become familiar with the evidence for use of these agents to reduce risk and improve outcomes in specific populations.

Introduction: Arterial hypertension is among the most important risk factors of atherosclerosis and associated cardiovascular pathology with a prevalence rate estimated at 20-30% of the adult population. Nowadays, it is recommended to perform an individual assessment of cardiovascular risk in a patient and to determine the threshold value for arterial hypertension, even though blood pressure classification values according to the European Society of Hypertension and the European Society of Cardiology (ESH/ESC), as well as the Polish Society of Hypertension (PTNT) have remained unchanged., Aim of Study: To determine what nurses with a Bachelor of Nursing degree know about the prevalence and classification of arterial blood pressure, as well as sequellae of arterial hypertension., Materials and Methods: This study was done in 116 qualified nurses (112 females, 4 males; age 21-50; seniority 0-29 years). The research period was from June 2007 to January 2008. The research tool was a questionnaire devised by the authors., Results: We found that half (on the average) of those questioned have an up-to-date knowledge regarding classification of blood pressure and prevalence of arterial hypertension but just one out of three respondents (on the average) was able to describe its sequellae. Relatively less known among nurses with a Bachelor of Nursing degree were aspects of "white coat hypertension". Statistically significant differences regarding correct answers were noted depending on seniority (p = 0.002), place of work p < 0.001), or position (p < 0.001). There were no differences depending on age, place of residence, marital status, or form of postgraduate education of nurses with a Bachelor of Nursing degree., Conclusion: It is necessary to improve knowledge among students of nursing (BN degree) about current classification of blood pressure, as well as prevalence of arterial hypertension and its sequellae.