Abstract:
Background: Elevated blood pressure is the leading cause of death worldwide; however, treat ment and control rates remain very low. An expanding literature supports the strategy of task
redistribution of hypertension care to nurses.
Objective: We aimed to evaluate the effect of a nurse-based hypertension management pro gram in Kenya.
Methods: We conducted a retrospective data analysis of patients with hypertension who initi ated nurse-based hypertension management care between January 1, 2011, and October 31,
2013. The primary outcome measure was change in systolic blood pressure (SBP) over one year,
analyzed using piecewise linear mixed-effect models with a cut point at 3 months. The primary
comparison of interest was care provided by nurses versus clinical officers. Secondary outcomes
were change in diastolic blood pressure (DBP) over one year, and blood pressure control analyzed
using a zero-inflated Poisson model.
Results: The cohort consisted of 1051 adult patients (mean age 61 years; 65% women). SBP
decreased significantly from baseline to three months (nurse-managed patients: slope –4.95
mmHg/month; clinical officer-managed patients: slope –5.28), with no significant difference
between groups. DBP also significantly decreased from baseline to three months with no differ ence between provider groups. Retention in care at 12 months was 42%.
Conclusions: Nurse-managed hypertension care can significantly improve blood pressure. How ever, retention in care remains a challenge. If these results are reproduced in prospective trial
settings with improvements in retention in care, this could be an effective strategy for hyper tension care w