Management of Uncontrolled Hypertension in a Nurse-Led Clinic Compared With Conventional Care for Patients with Type 2 Diabetes

OBJECTIVE — To compare the effectiveness of a nurse-led hypertension clinic with conven-tional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes. RESEARCHDESIGNANDMETHODS — We studied 120 men and women outpatient attendees (61 % non-Caucasian) with type 2 diabetes and a seated blood pressure (BP)140/80 mmHg. All patients were being treated for hypertension, and 71 % had increased urinary albumin excretion (UAE). Patients were allocated to either a nurse-led hypertension clinic or conventional primary care. The primary outcome measure was a change in systolic BP. Secondary outcome measures were total cholesterol, HDL cholesterol, total triglycerides, HbA1c, UAE, serum creat-inine, and changes in absolute stroke and coronary heart disease (CHD) risk scores. RESULTS — The mean (95 % CI) difference in the decrement of systolic BP was 12.6 mmHg (5.9–19.3) (P 0.000) in favor of the nurse-led group, whose patients were three times more likely to a reach target systolic BP140 mmHg compared with conventional care (P 0.003). A significant fall in 10-year CHD (P 0.004) and stroke risk (P 0.000) scores occurred only in the nurse-led group. There were no significant differences in the reduction of diastolic BP o