Nurse-led disease management for XXXX control in a diverse urban community: a randomized trial.

@entity1 @entity2316 @entity101
BACKGROUND: Treated but uncontrolled @entity101 is highly prevalent in African American and Hispanic communities. OBJECTIVE: To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager. DESIGN: Randomized controlled effectiveness trial. @entity1 : Four hundred and sixteen African American or Hispanic @entity1 with a history of uncontrolled @entity101 . @entity1 with blood pressure >= 150/95, or >= 140/85 for @entity1 with @entity2316 , at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City. INTERVENTION: @entity1 were randomized to receive usual care or a home blood pressure monitor plus one in- @entity1 counseling session and 9 months of telephone follow-up with a registered nurse. During the trial, the home monitor alone arm was added. MAIN MEASURES: Change in systolic and diastolic blood pressure at 9 and 18  months. KEY RESULTS: Changes from baseline to 9  months in systolic blood pressure relative to usual care was -7.0  mm Hg (Confidence Interval [CI], -13.4 to -0.6) in the nurse management plus home blood pressure monitor arm, and +1.1  mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm. No statistically significant differences in systolic blood pressure were observed among treatment arms at 18  months. No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18  months. Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm. CONCLUSIONS: A nurse management intervention combining an in- @entity1 visit, periodic phone calls, and home blood pressure monitoring over 9  months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.
