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Br J Gen Pract. 2005 January 1; 55(510): 53.
PMCID: PMC1266244

Nurse-led management of hypertension

Pippa Oakeshott, Senior Lecturer in General Practice
St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. E-mail:
Sally Kerry, Senior Lecturer in Medical Statistics, Sally Dean, Research Nurse in Cardiovascular Disease, and Franco Cappuccio, Professor of Clinical Epidemiology and Primary Care

In their comprehensive review of recent advances in cardiology in primary care, Fahey and Schroeder1 looked at new models of care including nurse-led management of hypertension. We analysed trials from UK general practices of change in systolic blood pressure after a nurse-led intervention until 2002. These showed a combined reduction in systolic blood pressure of only 3mm Hg — a fall that could just be due to accommodation.2 By contrast the landmark American Hypertension Detection and Follow-up trial showed that an organised system of regular follow up and review of hypertensive patients using a stepped care approach to treatment reduced not only blood pressure but also mortality over 5 years.3 The vital difference between this and the British community-based trials is that it included change in drug treatment to achieve target blood pressure.

The introduction of quality payments is encouraging UK general practices to improve management of people with high blood pressure. Although not yet tested in randomised trials, it is likely that this will involve an enhanced role for practice nurses. This could include adherence to protocols, agreed target blood pressure, better prescribing and compliance, and regular follow up.4 The development of supplementary prescribing by practice nurses will also be important. What a pity that the new NICE (National Institute of Clinical Excellence) recommendations for management of hypertension in primary care fail to include the simple, user-friendly British Hypertension Society ABCD guidelines.5


1. Fahey T, Schroeder K. Cardiology. Br J Gen Pract. 2004;54:695–702. [PMC free article] [PubMed]
2. Imperial Cancer Research Fund OXCHECK Study Group. Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year. BMJ. 1994;308:308–312. [PMC free article] [PubMed]
3. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program cooperative Group. 1979. JAMA. 1997;277:157–166. [PubMed]
4. Oakeshott P, Kerry S, Austin A, Cappuccio F. Is there a role for nurse-led blood pressure management in primary care? Fam Pract. 2003;20(4):469–473. [PubMed]
5. Brown MJ, Cruickshank JK, Dominiczak AF, et al. Better blood pressure control: how to combine drugs. J Hum Hypertens. 2003;17(2):81–86. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners