EFFECTIVENESS OF NURSE-LED INTERVENTIONS IN MANAGING HYPERTENSION AMONG OLDER ADULTS

Abstract

Background: Hypertension is highly prevalent among older adults and remains a major contributor to cardiovascular morbidity and mortality, particularly in low and middle-income countries. In Pakistan, inadequate blood pressure control among older adults is frequently observed due to poor medication adherence, insufficient lifestyle modification, and limited continuity of care. Nurse-led interventions have emerged as a practical approach to address these gaps through structured education, regular follow-up, and patient empowerment. Objective: To evaluate the effectiveness of a structured nurse-led intervention in improving blood pressure control, medication adherence, and lifestyle behaviours among older adults with hypertension in a tertiary care hospital setting in Pakistan. Study Design: Prospective two-arm controlled clinical evaluation. Settings: Tertiary care hospital in Pakistan. Duration of Study: January to July 2025. Methods:  A total of 90 hypertensive adults aged 60 years or older were enrolled and allocated into an intervention group (n = 45) and a control group (n = 45). The intervention group received structured nurse-led hypertension management in addition to usual care, while the control group received usual care alone. The nurse-led program comprised individualised education, medication counselling, lifestyle modification guidance, home blood pressure monitoring support, and scheduled follow-up visits with telephone reinforcement. Blood pressure was measured at baseline and at 12 weeks. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale. Between-group comparisons were performed using appropriate statistical tests, and multivariable logistic regression analysis was conducted to identify independent predictors of blood pressure control. Results:  Baseline demographic and clinical characteristics were comparable between the two groups. At 12 weeks, the intervention group demonstrated significantly greater reductions in systolic blood pressure (−15.2 ± 9.4 mmHg vs −6.1 ± 8.8 mmHg) and diastolic blood pressure (−7.8 ± 6.2 mmHg vs −2.9 ± 5.9 mmHg) compared with the control group (p < 0.001 for both). Blood pressure control, defined as <140/90 mmHg, was achieved in 68.9% of participants in the intervention group versus 40.0% in the control group (p = 0.006). Medication adherence scores improved significantly in the intervention arm, accompanied by favourable changes in dietary salt intake and physical activity. Nurse-led intervention independently predicted blood pressure control at 12 weeks (adjusted OR 3.18, 95% CI 1.30–7.79). Conclusion: Structured nurse-led hypertension management significantly improves blood pressure control, medication adherence, and lifestyle behaviours among older adults. Integration of nurse-led interventions into routine clinical practice may offer a scalable and cost-effective strategy to enhance hypertension outcomes in resource-limited settings.