Impact of Advanced Practical Nursing Intervention Versus Usual Care on Hypertension Control : Retrospective Study

Not yet recruiting

Brief Summary: Hypertension is the most frequent chronic pathology in France and in the world. It is one of the main modifiable cardiovascular risk factors. In France, 50% of treated hypertensives are uncontrolled and only 30% of treated patients are fully adherent to their antihypertensive treatment. Poor adherence to drug treatments is considered as one of the main causes of non-control of hypertension.

Since 2018, a new profession has entered the French healthcare system: Advanced Practice Nurses (APN). They have many broad skills, at the interface of nursing and medical exercises.

The purpose of this interventional study is to assess the impact of APN on blood pressure (BP) control in the context of usual care of hypertension thanks to a better adhesion of patients and a better therapeutic alliance.

The hypothesis formulated is that an individual APN intervention, included in a usual hypertension management, improves BP control.

Detailed Description: Hypertension is the most frequent chronic pathology in France and in the world. It is one of the main modifiable cardiovascular risk factors. In France, 50% of treated hypertensives are uncontrolled and only 30% of treated patients are fully adherent to their antihypertensive treatment. Poor adherence to drug treatments is considered as one of the main causes of non-control of hypertension.

Since 2018, a new profession has entered the French healthcare system: Advanced Practice Nurses (APN). They have many broad skills, at the interface of nursing and medical exercises.

The purpose of this interventional study is to assess the impact of APN on blood pressure (BP) control in the context of usual care of hypertension thanks to a better adhesion of patients and a better therapeutic alliance.

The hypothesis formulated is that an individual APN intervention, included in a usual hypertension management, improves BP control.

This study will be a retrospective quasi-experimental study, conducted at the Diagnosis and Therapeutic Center of the Hôtel-Dieu University Hospital, Assistance Publique - Hôpitaux de Paris, France. The timeframe of the study should is from September 2020 to July 2023.

Recruitment & Eligibility

Inclusion Criteria

adult patient
being diagnosed with essential hypertension,
being followed by a MD of the structure for hypertension management,
having received a proposition to meet an APN for hypertension management between the day hospitalization and the next MD consultation,
having received a loaned tensiometer with instructions during the day hospitalization and explanations for HBPM protocol.

Exclusion Criteria

being diagnosed with secondary hypertension,
having APN follow-up before the day hospitalization,
being lost to follow-up in the twelve months after the MD consultation
not having the BP measurement by OBPM for the day hospitalization (baseline) and/or the endline (endline),
pregnancy
under guardianship or tutorship
State Medical Help

Arm && Interventions

Group	Intervention	Description
Patients without APN intervention	No APN intervention	Participants with a MD consultation only, within approximately 2 to 12 months
Patients with APN intervention	APN intervention	Participants with a schedule of a MD consultation (within approximately 2 to 12 months) + an APN intervention halfway between day hospitalization et MD consultation

Primary Outcome Measures

Name	Time	Method
Blood pressure (BP) control	Between 2 to 12 months	Blood pressure (BP) control in MD consultation * Rate of BP control (BP \< 140/90 mmHg) * Mean (SD) of both systolic and diastolic BP

Secondary Outcome Measures

Name	Time	Method
Therapeutic adjustments	Between 2 to 12 months	Group with APN : Therapeutic adjustments and their indication(s) by the APN. Dichotomous variables: therapeutic adjustments (yes/no) and their indication(s): inefficacy (yes/no) and intolerance (yes/no).
Blood pressure (BP) control	Between 2 to 12 months	Evolution of BP control between day hospitalization and MD consultation. 3-category variable: now controlled, stable, no longer controlled
Home blood pressure monitoring (HBPM)	Between 2 to 12 months	Performance and quality of home BP monitoring (HBPM). 3-category variable: HBPM perfectly performed, HBPM poorly performed, and HBPM not performed.

Locations (1): Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris
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Paris, Ile De France, France