Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work.

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Abstract
In this randomized controlled trial, the value of using occupational health nurses (OHNs) to monitor the care of hypertensive employees at work was compared with regular care (RC) delivered in the community. One year after entry, the blood pressure level, the medication history, the compliance with treatment and the cost of hypertensive care of the participants were determined by independent evaluators. The reduction in diastolic blood pressure (DBP), the measure of effectiveness, was 10.5 .+-. 1.1 mm Hg (mean .+-. SEM [standard error of the mean]) in the OHN group and 7.7 .+-. 1.1 mm Hg in the RC group; the proportion under good blood pressure control was 41.8% and 31.0% respectively. These between-group differences were not statistically significant. Although the employees in the OHN group were more medicated and had a lower treatment dropout rate, neither difference was statistically significant. In addition, the proportion of employees who were compliant with prescribed medication was virtually identical in both groups. Monitoring the blood pressure of hypertensive employees at work is neither clinically effective nor cost-effective. Moreover, there is still a significant gap between the control of blood pressure that is potentially achievable with a systematic aggressive approach to treatment, and the usual care being delivered in communities at present.