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Family Practice Advance Access published online on January 17, 2005
Family Practice, doi:10.1093/fampra/cmh717
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Family Practice © Oxford University Press 2005, all rights reserved.
Received June 10, 2004
Accepted September 27, 2004

Article

Nurse-led adherence support in hypertension: a randomized controlled trial

Knut Schroeder 1*, Tom Fahey 2, Sandra Hollinghurst 1, and Tim J. Peters 1

1 Primary Health Care, Department of Community Based Medicine, University of Bristol, UK
2 Tayside Centre for General Practice, University of Dundee, UK

* To whom correspondence should be addressed.
Knut Schroeder, E-mail: k.schroeder{at}bristol.ac.uk


  Abstract

Background. Lack of medication adherence is a common reason for poor control of blood pressure in the community, increasing the risk of heart attacks and strokes.

Objective. To evaluate the effect of nurse-led adherence support for people with uncontrolled high blood pressure compared with usual care.

Methods. We recruited 245 women and men with uncontrolled hypertension (≥150/90 mmHg) from 21 general practices in Bristol, UK. Participants were randomized to receive nurse-led adherence support or usual care alone. Main outcome measures were adherence to medication (‘timing compliance’) and blood pressure.

Results. Mean baseline timing compliance (± SD) was high in both the intervention (90.8 ± 15.6%) and the control group (94.5 ± 7.6%). There was no evidence of an effect of the intervention on timing compliance at follow-up (adjusted difference in means -1.0%; 95% confidence interval (CI) -5.1 to 3.1). There was also no difference at follow-up between the groups with regard to systolic blood pressure (-2.7 mmHg; 95% CI -7.2 to 1.8) or diastolic blood pressure (0.2 mmHg; 95% CI -1.9 to 2.3). Projected costs for the primary care sector per consultation were £6.60 for the intervention compared with £5.08 for usual care.

Conclusion. In this study, adherence to blood pressure medication was much higher than previously reported. There was no evidence of an effect of nurse-led adherence support on medication adherence or blood pressure compared with usual care. Nurse-led adherence support was also more expensive from a primary care perspective.

Keywords: Clinical trial; hypertension; patient compliance; nursing care.
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