Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention

Scand J Prim Health Care. 2024 Jun;42(2):347-354. doi: 10.1080/02813432.2024.2326470. Epub 2024 Mar 8.

Abstract

Objective: A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model.

Design and setting: Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention.

Intervention: Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols.

Patients: Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively.

Main outcome measures: Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on -0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured.

Results: In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%-61% (control 50%-52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%-40% (control 36%-36%), p = .043, and digit preference decreased, 39%-27% (control 41%-35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 - 1.64 (control 1.62 - 1.62), non-significant, but drug choice changed in line with recommendations.

Conclusion: Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.

Keywords: blood pressure; hypertension; intervention; nurse; primary healthcare.

Plain language summary

Hypertension is common and often suboptimally treated in relation to existing guidelines.This register study evaluates the results of a staff training intervention promoting nurse-led care.The intervention had an impact on measurement techniques, drug choice and improved cholesterol control.

MeSH terms

  • Antihypertensive Agents* / therapeutic use
  • Blood Pressure / physiology
  • Cholesterol
  • Cholesterol, LDL / pharmacology
  • Cholesterol, LDL / therapeutic use
  • Humans
  • Hypertension* / epidemiology
  • Pilot Projects
  • Primary Health Care

Substances

  • Antihypertensive Agents
  • Cholesterol, LDL
  • Cholesterol

Grants and funding

The study was financed by the Local Research and Development Council, Skaraborg, Sweden, received funds from the Local Research and Development Board for Södra Älvsborg (grant number VGFOUSA-937483) and was supported by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (grant number ALFGBG-965244).