Lia Gedamu, DNP, MSN, AGPCNP-BC

Abstract:

Background: Hypertension (HTN) affects about 75 million adults in the United States. HTN significantly contributes to morbidity, mortality, and healthcare costs. In the U.S., only 50% of over 10 million young adults with HTN have optimal blood pressure (BP) control. According to the University of California (UC) Health Hypertension dashboard, the overall average for blood pressure control in 2024 was 71.5% for UC Los Angeles (UCLA) compared to the UC average of 72.5%. The management of HTN can reduce future healthcare costs, morbidity, and mortality. Evidence from several randomized controlled trials demonstrated that lowering bloodpressure can reduce cardiovascular disease risks. Purpose: The project aimed to assess the impact of virtual nurse-led HTN management incorporating home blood pressure (BP) monitoring and lifestyle modification education on BP control and self-care behavior over two months. Methods: The Doctor of Nursing Practice (DNP) student collaborated with the UCLA Department of Medicine (DOM) quality team and a primary care physician to co-lead a virtual nurse-led HTN management pilot study. The intervention included biweekly virtual/phone visits, lifestyle modification counseling, and home BP monitoring based on the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines, utilizing motivational interviewing techniques. Ten adult primary care patients with a primary hypertension diagnosis were recruited through MyChart messaging and three outreach phone calls. Participants measured their BP at home and reported the readings every two weeks. The DNP student provided tailored feedback and counseling based on blood pressure readings and self-care behaviors. Participants completed a hypertension self-care profile survey during the initial and final virtual visits. Results: The baseline sample included 10 individuals with primary hypertension, who self-reported race as: African American (6), Black (2), and African (2). The mean age was 57.1 years, 80% of the participants were female, and 50% were married. Paired-samples t-tests were performed to evaluate the effectiveness of the virtual nurse-led hypertension management intervention in reducing blood pressure. Six paired comparisons were performed between pre- and post-intervention blood pressure measurements. The following statistically significant differences were identified: Pre and post morning (AM) and evening before supper (PM) systolic blood pressure (SBP): M difference = 9.63, t (8) = 2.47, p = .039, d = 0.824. Pre and post PM SBP M difference = 7.20, t (8) = 2.68, p = .028, d = 0.892.  Pre and post average SBP: M difference = 8.47, t (8) = 3.10, p = .015, d = 1.033. These results demonstrate statistically significant reductions in systolic blood pressure post-intervention, with effect sizes ranging from medium to large. For diastolic measures, results were more mixed: Pre and post AM diastolic blood pressure (DBP): M difference = 6.04, t (8) = 2.00, p = .080, d = 0.743. Pre and post PM DBP: M difference = 2.99, t (8) = 1.77, p = .115, d = 0.590. Pre and post average DBP: M difference = 4.52, t (8) = 2.24, p = .055, d = 0.746. While none of the diastolic comparisons reached conventional significance (p < .05), the average diastolic reduction approached significance and showed a moderate effect size, further confirming the clinical significance of the intervention. 

The pre- and post-intervention self-care behavior was compared. Notable results include question one, self-care motivation to check blood pressure at home daily, which improved significantly (Wilcoxon, p = .006). Question four, reading nutrition facts labels for sodium content, showed a significant improvement (Wilcoxon p = .01). Question five, participating in regular exercise, and question eight, engaging in activities to lower stress, also demonstrated significant post-intervention improvements (p = .011 and p = .025, respectively). The post-intervention total self-care score increased significantly (p = .011). Questions Q2 (taking BP medication regularly), Q3 (Eating fruits & vegetables daily), Q6 (avoiding drinking), and Q7 you can(practicing non-smoking) did not reach statistical significance, although positive trends were observed. Participants also completed an end-of-intervention satisfaction survey with eight questions rated on a scale from -2 (Strongly Disagree) to 2 (Strongly Agree). The average score across all questions ranged from 1.7 to 2.0. Conclusions and Implications: This virtual nurse-led hypertension management pilot project, which integrated home blood pressure (BP) monitoring and lifestyle modification education counseling (awareness of sodium content, regular physical activity, stress management), enhanced BP and self-care behaviors, The intervention produced statistically significant reductions in systolic blood pressure and significant improvements in diastolic pressure among the participants. Effect sizes ranged from medium to large. For diastolic measures, results were more mixed: Pre and post AM diastolic blood pressure (DBP): M difference = 6.04, t (8) = 2.00, p = .080, d = 0.743. Pre and post PM DBP: M difference = 2.99, t (8) = 1.77, p = .115, d = 0.590. Pre and post average DBP: M difference = 4.52, t (8) = 2.24, p = .055, d = 0.746. While none of the diastolic comparisons reached conventional significance (p < .05), the average diastolic reduction approached significance and showed a moderate effect size, further confirming the clinical significance of the intervention. 

The pre- and post-intervention self-care behavior was compared. Notable results include question one, where self-care motivation to check blood pressure at home daily improved significantly (Wilcoxon, p = .006). Question four, reading nutrition facts labels for sodium content, showed a significant improvement (Wilcoxon p = .01). Question five, participating in regular exercise, and question eight, engaging in activities to lower stress, also demonstrated significant post-intervention improvements (p = .011 and p = .025, respectively). The post-intervention total self-care score increased significantly (p = .011). Questions Q2 (taking BP medication regularly), Q3 (Eating fruits & vegetables daily), Q6 (avoiding drinking), and Q7 you can(practicing non-smoking) did not reach statistical significance, although positive trends were observed. Participants also completed an end-of-intervention satisfaction survey with eight questions rated on a scale from -2 (Strongly Disagree) to 2 (Strongly Agree). The average score across all questions ranged from 1.7 to 2.0. Conclusions and Implications: This virtual nurse-led hypertension management pilot project, which integrated home blood pressure (BP) monitoring and lifestyle modification education counseling (awareness of sodium content, regular physical activity, stress management), enhanced BP and self-care behaviors, The intervention produced statistically significant reductions in systolic blood pressure and significant improvements in diastolic pressure among the participants. Effect sizes ranged from medium to large for changes in systolic blood pressure, and moderate for diastolic blood pressure, suggesting a meaningful clinical impact. These findings support the continued application and evaluation of similar interventions in broader populations to reduce cardiovascular risk through improved BP control. The pilot project presented a scalable and effective model for managing hypertension in primary care settings, examining its impact on both practice and research.

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