Frequent nurse visits decrease white coat effect in stage III hypertension

Abstract Arterial hypertension is a public health problem and patient adherence to treatment is challenging. This study tested whether frequent nurse visits provide additional benefits to antihypertensive treatment. Every 30 days, a pharmacist visited these patients to deliver antihypertensive drugs and perform a pill count. Nurses visited group A (48 patients) every 15 days and group B (52 patients) every 90 days. Ambulatory blood pressure (BP) monitoring was performed 15 and 180 days after randomization. At randomization, groups A and B had the same clinical systolic (191 ± 5 v 186 ± 3 mm Hg) and diastolic BP levels (122 ± 3 v 117 ± 4 mm Hg), respectively. After 90 days, BP declined more in group A than in group B (35 ± 5/19 ± 3 v 27 ± 5/9 ± 3 mm Hg). At 180 days, the difference increased because the reduction persisted in group A but decreased in group B (36 ± 6/21 ± 4 v 17 ± 4/10 ± 2 mm Hg). The mean ambulatory BP monitoring values were similar in both groups at 15 and 180 days. However, the attenuation of the clinic–daytime BP difference was larger in group A than in group B (systolic, −13 ± 4 v −3 ± 4 mm Hg; diastolic −11 ± 3 v −4 ± 3 mm Hg). The patients with clinic–daytime differences decreased more in group A (systolic, 16 to 10; diastolic, 20 to 14) than in group B (systolic, 19 and 20; diastolic, 22 and 22). These data indicate that frequent nurse visits significantly attenuate the white coat effect (clinic daytime BP difference).