The effect of continuous nursing intervention guided by chronotherapeutics on ambulatory blood pressure of older hypertensive patients in the community

• Published in: Journal of clinical nursing 2014-08, Vol.23 (15-16), p.2247-2255
• Main Authors: Cheng, Mei, Cheng, Shu-Ling, Zhang, Qing, Jiang, He, Cong, Ji-Yan, Zang, Xiao-Ying, Zhao, Yue
• Format: Article
• Language: English
• Subjects: Aged; ambulatory blood pressure monitoring; Antihypertensive Agents - administration & dosage; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Chronotherapy; Community Health Nursing; continuous nursing intervention; Effects; Female; Humans; Hypertension; Hypertension - drug therapy; Hypertension - nursing; Intervention; Male; Middle Aged; Nurses; Nursing; Patients; Practice Patterns, Nurses; primary hypertension
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.12502

Aims and objectives To explore the effect of continuous nursing intervention guided by chronotherapeutics so as to provide the easy, noninvasive, effective and acceptable intervention for older hypertensive patients in the community. Background Many researchers studied the effect of administration at different times on blood pressure control and circadian rhythm. However, the individual administrative time was set ambiguously in previous studies. Design A semi‐experimental study. Methods In the study, 90 eligible patients were recruited and separated into three groups randomly, which were the control group, intervention group A (behaviour and chronotherapy intervention) and intervention group B (behaviour intervention). At 6 and 12 months after the study, the intervention groups were measured 24‐hour ambulatory blood pressure monitoring. Results There were significant differences in ambulatory blood pressure monitoring parameters of the two intervention groups at different measurement times, and there were interaction between measurement time and different groups. The number of patients with dipper increased and reverse dipper decreased in group A as the intervention applied. There were statistical differences between two groups. The number of patients with morning surge in group A decreased more, and there were statistical differences between two groups at six months after the intervention. Conclusions The behaviour and chronotherapy intervention based on the patients' ambulatory blood pressure monitoring can control casual blood pressure much better and last longer, which can also improve patients' indexes of ambulatory blood pressure monitoring better than behaviour intervention only. The behaviour and chronotherapy intervention can increase patients' nocturnal blood pressure drop, increase the number of patients with dipper and decrease reverse dipper, and improve blood pressure surge in the morning. Relevance to clinical practice Nurses can use continuous nursing intervention guided by chronotherapeutics to help improve hypertension of older patients better in the community.