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Swapping GPs for nurses eases white-coat hypertension

Swapping a GP for a nurse is an effective way of eradicating white-coat hypertension, because it relaxes patients and lowers their blood-pressure readings, new research reveals.

A UK meta-analysis of 14 studies found that mean blood pressures measured by nurses were 8.5/4.2mmHg lower than readings from doctors.

It concluded that blood pressure measurements from GPs might be ‘unreliable for
clinical decisions', and that all measurements should be delegated to nurses – in a recommendation with wide-ranging implications for how practices organise services.

When studies with a high risk of bias were removed from the analysis, the gap was reduced but remained, with a mean difference of 4.8mmHg in systolic blood pressure and 1.5mmHg for diastolic.

The difference in diastolic readings was not found to be statistically significant.

Researchers told the European Society of Hypertension Congress in London last month, that the findings meant practices should move to nurse-only or home blood pressure monitoring.

Study leader Dr Chris Clark, clinical academic fellow at the Peninsula Medical School and a GP in Witheridge, Devon, said: ‘The difference could affect treatment decisions, especially when the measurement is marginal, between one course of treatment and another.

‘The study might lead to a move to nurses taking blood pressure or increased use
of home blood pressure readings.'

Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and GP in Letchworth, said the study was ‘useful'.

He added: ‘I always ask the nurse to take the reading before the patient leaves.

‘It's a very good idea to get patients to buy their own home blood pressure machines. They're only £10-15.'