A comparison of the management of hypertensive patients by nurse practitioners compared with conventional hospital care.

Patients with hypertension (n = 198) managed by a nurse practitioner hypertension clinic (NPC) were compared over a four-year period with an age-sex matched group of patients attending conventional hospital hypertension outpatient clinics (CHC) for follow-up in two other hospitals in the same city. Mortality is reported for an additional two years from initial presentation. There was no difference between the groups for initial supine systolic or diastolic blood pressure, weight, obesity index, alcohol use, cholesterol or glucose. The reported causes of hypertension were similar. There were more smokers initially in the CHC (46% vs. 37%). Initial drug treatment was less varied in the NPC. At the end of one year there was no significant weight loss in either group, and drug treatment was broadly similar between the two groups. Those attending the NPC, however, had a greater decrease in both supine systolic blood pressure (P less than 0.05) and diastolic blood pressure (P less than 0.01). At the end of four years there were 136 patients (69%) attending the NPC and 70 (35%) remaining in the CHC. For those remaining systolic blood pressure control was similar. Diastolic blood pressures were lower in the NPC (P less than 0.001). Mortality was not significantly different between the groups over a six-year period. This study shows that a nurse practitioner clinic can control blood pressure in a greater proportion of patients, maintain contact with more efficient follow-up of a greater percentage of patients and collect the information needed to assess the effectiveness of care over the long term.