Nurse-measured and physician-measured blood pressure: relationship to ambulatory blood pressure and left ventricular mass

BACKGROUND: In the present study we evaluated the influence of the observer 's status -physician or nurse-on blood pressure levels and the relationship among clinic blood pressure measurement with ambulatory blood pressure and left ventricle mass. PATIENTS AND METHODS: cross sectional study performed in seven primary care centers. Participating physicians and nurses were trained for blood pressu re measurement prior to the study and subsequently retrained at 3 month int ervals during the study. Patients included in the study were 122 subjects w ith mild to moderate hypertension who underwent the following study protoco l: al measurement of clinic blood pressure by physician and nurse, in an in dependent fashion, on 3 visits; b) clinic-epidemiologic questionnaire;c) co nventional hematological and biochemical study; dl electrocardiogram; e) 24 -hour ambulatory blood pressure monitoring, f) M-mode and Doppler echocardi ography (only in 58 subjects). RESULTS: Nurse,measured blood pressure levels were higher than those determ ined by physicians (mean differences: 3.9 [6.7] mmHg in systolic blood pres sure and 2.6[5.4] mmHg in diastolic blood pressure). The blood pressure lev el differences between the two observers were higher in female patients and subjects with low educational level, independently of the observers gender . Nurse-measured blood pressure was more closely related to ambulatory bloo d pressure and left ventricle mass than physician-measured blood pressure. CONCLUSIONS: Nurse-measured blood pressure levels are lower than those dete rmined by physicians and more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure. These data support that nurses, instead of doctors, should routinely measure blood pre ssure in primary care centers.