Apr. 24, 2001 ROCHESTER, MINN. -- Using a physician/nurse team to rapidly adjust blood pressure drug dosage can significantly improve hypertension control rates and potentially reduce costs, according to a Mayo Clinic study published in the April issue of the American Journal of Hypertension.
Commonly referred to as the silent killer, uncontrolled hypertension prematurely ages arteries and can lead to stroke, heart attack and kidney failure. Only 27 percent of the nearly 50 million Americans who have hypertension keep it under control (blood pressure less than 140/90). The blood pressure control rate at the latest follow-up in the Mayo Clinic study was 75 percent.
The study examined the use of rapid medication dosage adjustments at Mayo Clinic’s Short-term Hypertension Care Clinic, a nurse-managed, physician-supervised treatment clinic. Each year over 7,500 patients are referred to trained nurses with specialized expertise at the clinic after physician evaluation. Most are seen two-to-three times a day by a nurse over three-to-four days before they return home to their doctor’s care. The study used semiautomatic home blood pressure measurements of 60 of those patients over 12 months of follow-up to see whether the favorable results achieved at the clinic continued over the long term.
"Many patients travel to Mayo Clinic from a great distance to be treated for other medical conditions, and in the course of their examination hypertension is discovered so they are referred to us," says Vincent Canzanello, M.D., a Mayo Clinic hypertension specialist and author of the study.
"This short-term clinic was developed in the 1980s to help get patients’ hypertension under control within a week, since we knew it would be impractical for them to return for medication adjustments over a period of months."
Conventional hypertension treatment typically involves monthly blood pressure checks followed by medication adjustments. The Mayo Clinic approach involves an initial consultation with a physician, who prepares the drug treatment plan and reviews it with the nurse who implements it. Patients then see the nurse several times over three or four days, and the nurse adjusts drug dosages as needed to bring blood pressure under control.
"Our model may have the potential to lower costs associated with hypertension because it requires fewer visits to the doctor," says Dr. Canzanello. "But more importantly, the long-term blood pressure control achieved through this system compares very favorably with the traditional dosage adjustment method, which may take several months."
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