Frequent nurse visits decrease white coat effect in stage III hypertension

• Published in: American journal of hypertension 2004-06, Vol.17 (6), p.523-528
• Main Authors: Guerra-Riccio, Grazia Maria, Artigas Giorgi, Dante Marcelo, Consolin-Colombo, Fernanda Marciano, Barreto-Filho, José Augusto Soares, Lopes, Heno Ferreira, Fleury Camargo, Ana L.úcia Rego, Moacyr Krieger, Eduardo
• Format: Article
• Language: English
• Subjects: adherence of patient; Adrenergic beta-Antagonists - therapeutic use; Aged; ambulatory blood pressure monitoring; Ambulatory Care; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; attention of patient; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory; Brazil; Calcium Channel Blockers - therapeutic use; Cardiology. Vascular system; Circadian Rhythm - drug effects; Circadian Rhythm - physiology; Diastole - drug effects; Diastole - physiology; Female; Follow-Up Studies; Humans; Hypertension; Hypertension - nursing; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Severity of Illness Index; Systole - drug effects; Systole - physiology; Treatment Outcome
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2004.02.007

Arterial hypertension is a public health problem and patient adherence to treatment is challenging. This study tested whether frequent nurse visits provide additional benefits to antihypertensive treatment. Every 30 days, a pharmacist visited these patients to deliver antihypertensive drugs and perform a pill count. Nurses visited group A (48 patients) every 15 days and group B (52 patients) every 90 days. Ambulatory blood pressure (BP) monitoring was performed 15 and 180 days after randomization. At randomization, groups A and B had the same clinical systolic (191 ± 5 v 186 ± 3 mm Hg) and diastolic BP levels (122 ± 3 v 117 ± 4 mm Hg), respectively. After 90 days, BP declined more in group A than in group B (35 ± 5/19 ± 3 v 27 ± 5/9 ± 3 mm Hg). At 180 days, the difference increased because the reduction persisted in group A but decreased in group B (36 ± 6/21 ± 4 v 17 ± 4/10 ± 2 mm Hg). The mean ambulatory BP monitoring values were similar in both groups at 15 and 180 days. However, the attenuation of the clinic–daytime BP difference was larger in group A than in group B (systolic, −13 ± 4 v −3 ± 4 mm Hg; diastolic −11 ± 3 v −4 ± 3 mm Hg). The patients with clinic–daytime differences decreased more in group A (systolic, 16 to 10; diastolic, 20 to 14) than in group B (systolic, 19 and 20; diastolic, 22 and 22). These data indicate that frequent nurse visits significantly attenuate the white coat effect (clinic daytime BP difference).