Improving Blood Pressure Control in Primary Care: The ImPress Study

Background: Hypertension is a significant health issue due to its global prevalence and role as a major risk factor for numerous life-limiting conditions, including cardiovascular disease (CVD), stroke, dementia and kidney disease^1,2. Effective management of hypertension is often challenging due to a combination of clinician inertia and low patient engagement evident across Australian communities³.

Enhancing general practice care has the potential to address key barriers to hypertension management and prevent needless death and disability associated with uncontrolled high blood pressure. The growth of the general practice nursing (GPN) workforce in Australia has created an opportunity to improve blood pressure management in this setting through a multidisciplinary approach^4,5. Despite the potential, evidence is sparse around the impact of GPN-led interventions on blood pressure and health outcomes⁶.

Aim: This Doctoral Project sought to evaluate the effectiveness of a GPN-led intervention to manage hypertension and explore participants' experiences in delivering and receiving this intervention.

Methods: This was a two-stage, sequential explanatory mixed methods project. The first stage was a cluster randomised control trial of a GPN-led intervention to improve blood pressure control in people with hypertension and at high risk of CVD^6,7. In stage two, a qualitative descriptive study was undertaken to explore the experiences of GPN, general practitioner (GP) and patient participants in the delivery and receipt of the intervention⁸. This study was significantly impacted by several climate disasters (bushfires and floods) and the COVID-19 pandemic⁹, which challenged the recruitment and retention of participants.

Findings: Twelve general practices actively engaged in the study. Of the 126 people with hypertension and high CVD risk screened, 65 eligible people were recruited (30 intervention and 35 control). Quantitative findings demonstrated no significant difference in systolic blood pressure between control and intervention groups at six months, however, a significant improvement was detected at 12 months (p=0.03)¹⁰.