Long-term outcomes after a structured hypertension education programme for patients with diabetes and hypertension
DOI:
https://doi.org/10.1002/edn.20Keywords:
diabetes mellitus, hypertension, patient education, blood pressure self-measurementAbstract
AbstractA structured hypertension treatment and education programme (HTEP) was developed in the Düsseldorf area in the 1990s for patients with diabetes mellitus and hypertension and was found to be effective in a randomised controlled trial. The German Association of Diabetes Education and Counselling Professions (VDBD) implemented the HTEP all over Germany in order to optimise the care of patients with diabetes and hypertension. The objectives of the HTEP are to enable patients to gain knowledge of hypertension, to participate actively in their treatment to improve blood pressure (BP) and metabolic control and to self-measure their BP.
The implementation consisted of two stages. The first stage comprised the training of 312 diabetes counsellors (DCs). During the second stage 473 patients with type 1 or type 2 diabetes and hypertension in 35 diabetes centres throughout Germany received the HTEP including instructions in BP self-measurement. The HTEP consists of four units each one with a duration of 90 minutes covering the topics: hypertension, BP self-monitoring according to the standards of the German Hypertension League, antihypertensive medication including effects and side effects, recommendations to moderate exercise, weight reduction, dietary advice with reference to reduction of salt and alcohol and normalising the intake of protein. These patients participated in a prospective non-experimental study with a follow up of three years investigating the long-term outcomes of the HTEP in uncontrolled settings. The DCs assessed the accuracy of patients’ self-monitoring by parallel measurement. Assessments included questionnaires evaluating patients’ understanding of hypertension and metabolic control.
The mean BP monitored by the DC fell from 150/85mmHg to 147/80mmHg (p<0.0001). The accuracy of self-measurements increased from 76% to 86% (p<0.005) and mean self-measurement readings decreased from 142/81mmHg to 139/78mmHg. HbA1c fell significantly from 7.9±1.6% to 7.3±1.1% (mean ± SD, p<0.001) and total cholesterol was lowered from 241±67.1mg/dl to 200±40.4mg/dl (p<0.001). Patients’ knowledge of hypertension increased from 62% before the intervention to 72% after three years’ follow up. Patients over 70 years showed less knowledge than younger patients (p<0.005).
It was concluded that the HTEP is effective in improving BP, metabolic control and knowledge of hypertension. It enables patients to measure their BP precisely and regularly.
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