EFFECTS OF SUPPORTED SELF-CARE ON BLOOD PRESSURE AND CARDIOMETABOLIC PROFILE OF HYPERTENSIVE INDIVIDUALS: RANDOMIZED CLINICAL TRIAL

ABSTRACT

Objective:

to verify the effects of supported self-care on the blood pressure and cardiometabolic profile of hypertensive individuals.

Method:

randomized clinical trial developed with 78 hypertensive patients monitored by the Family Health Strategy in the municipality of Cajazeiras - PB - Brazil. The intervention consisted of nursing consultations based on supported self-care. The control group followed up with the usual monitoring by the health team. For data collection, a sociodemographic and clinical questionnaire, blood tests, blood pressure and anthropometric measurements were used.

Results:

There was a reduction in weight, abdominal circumference, waist-to-hip ratio, and Body Mass Index in the intervention group, with significant improvement in blood pressure. No significant improvement was seen in the control group.

Conclusion:

supported self-care showed positive effects on the participants’ blood pressure and cardiometabolic profile, minimizing risk factors and configuring a methodology with promising potential when applied by nurses. REBEC - RBR-5m5qg8

DESCRIPTORS:
Hypertension; Self-care; Cardiometabolic Risk Factors; Health Profile; Nursing consultation

RESUMO

Objetivo:

verificar os efeitos do autocuidado apoiado sobre o perfil pressórico e cardiometabólico de hipertensos.

Método:

ensaio clínico randomizado desenvolvido com 78 hipertensos acompanhados pela Estratégia Saúde da Família do município de Cajazeiras - PB - Brasil. A intervenção consistiu na aplicação de consultas de enfermagem baseadas no autocuidado apoiado. O grupo controle seguiu com o acompanhamento habitual da equipe de saúde. Para a coleta de dados foi utilizado um questionário sociodemográfico e clínico, análise de sangue, verificação da pressão arterial e das medidas antropométricas.

Resultados:

houve redução do peso, da circunferência abdominal, da relação cintura/quadril e do Índice de Massa Corporal no grupo intervenção, com melhora significativa da pressão arterial. Nenhuma melhora significativa foi visualizada no grupo controle.

Conclusão:

o autocuidado apoiado mostrou efeitos positivos sobre o perfil pressórico e cardiometabólico dos participantes, minimizando fatores de risco e configurando uma metodologia com potencial promissor quando aplicada pelo enfermeiro. REBEC - RBR-5m5qg8.

DESCRITORES:
Hipertensão Arterial; Autocuidado; Fatores de Risco Cardiometabólico; Perfil de Saúde; Consulta de Enfermagem

RESUMEN

Objetivo:

verificar los efectos del autocuidado apoyado en la presión arterial y el perfil cardiometabólico de los pacientes hipertensos. Material y método: ensayo clínico aleatorio desarrollado con 78 pacientes hipertensos controlados por la Estrategia de Salud de la Familia en el municipio de Cajazeiras - PB - Brasil. La intervención consistió en la aplicación de consultas de enfermería basadas en el autocuidado apoyado. El grupo de control siguió con el control habitual del equipo sanitario. Para la recogida de datos se utilizó un cuestionario sociodemográfico y clínico, análisis de sangre, presión arterial y mediciones antropométricas.

Resultados:

hubo una reducción del peso, la circunferencia abdominal, la relación cintura/cadera y el índice de masa corporal en el grupo de intervención, con una mejora significativa de la presión arterial. No se observó ninguna mejora significativa en el grupo de control.

Conclusión:

el autocuidado apoyado mostró efectos positivos sobre la presión arterial y el perfil cardiometabólico de los participantes, minimizando los factores de riesgo y configurando una metodología con un potencial prometedor cuando es aplicada por las enfermeras. REBEC - RBR-5m5qg8.

DESCRIPTORES:
Hipertensión; Autocuidado; Factores de Riesgo Cardiometabólico; Perfil de Salud; Enfermería de Consulta

INTRODUCTION

Arterial Hypertension (AH) reflects a topic of public interest as it is a chronic disease on the rise. Affecting about one third of the adult population, AH was responsible for 2.1% of deaths worldwide in 2019, taking a prominent place in the global burden of cardiovascular disease and disability-adjusted life years¹. In Brazil, the prevalence of AH in this same period was 24.5% in people older than 18 years, distributed in 27.3% among women and 21.2% among men, with mortality corresponding to 20.4% of total deaths in the country².

The subject in question raises social repercussions related to unsatisfactory control of hypertensive disease ³. According to the National Health Survey (PNS), 4.7% of the population has an intense or very intense degree of limitations in daily activities due to high blood pressure (BP)⁴. These findings are associated with overweight, large abdominal circumference (AC), physical inactivity, and dyslipidemia⁵.

In this sense, antihypertensive therapy should be directed to the elaboration of collective policies combined with individual actions, aiming at the achievement of ideal blood pressure goals, and the prevention of cardiovascular and renal outcomes, with the patient being oriented to start practices that lead to changes in lifestyle³,⁶.

However, what is perceived are ineffective results on disease control, particularly regarding the maintenance of healthy behaviors⁷. Supported self-care emerges in this scenario as one of the pillars of the Chronic Conditions Care Model (MACC), aiming to reformulate the predominant biomedical care that has not shown effective impacts in the field of chronic conditions. It is based on the premise of empowerment and preparation of individuals for self-management of their own health conditions ⁸,⁹.

Supported self-care uses a systematized approach that aims to support the process of changing habits. It includes periodic follow-up, goal setting, and the construction of an individualized care plan. It also allows the recognition of the personal interest in modifying a risk behavior so that a counseling is carried out centered on the person, his/her wills, and availability of resources⁷,⁹.

Thus, given the public and social importance of hypertension today, confirmed by the expressivity of epidemiological data, this study aimed to verify the effects of supported self-care on the blood pressure and cardiometabolic profile of people with hypertension. Based on the findings that indicate the benefits of supported self-care on the management of chronic diseases, the hypothesis is that the nursing consultation guided by supported self-care stimulates the acquisition of healthy behaviors by the patient, improving cardiometabolic variables and blood pressure levels.

The present proposal is justified by the opportunity to test a new format of assistance, based on the decentralization of care and the active involvement of the patient, where the use of an innovative methodology, focused on health education, can contribute to a greater accountability of the patient on his treatment process with consequent improvement of the results on risk behaviors and reduction of cardiovascular events.

METHOD

This is a randomized clinical trial (RCT), parallel, with two arms, developed from January to July 2020, with hypertensive patients followed-up in 11 units of the Family Health Strategy (FHS), in the city of Cajazeiras - PB. This RCT is part of the doctoral thesis entitled “Nursing consultation based on supported self-care in users with hypertension followed-up in the Family Health Strategy” and has the number in the Brazilian Registry of Clinical Trials (REBEC) RBR-5m5qg83.

Inclusion criteria were age > 18 years; medical diagnosis of arterial hypertension; antihypertensive treatment for a period of at least six months before the beginning of this study and follow-up by a nurse at the FHS. People with cognitive impairment regarding memory, attention and communication skills and pregnant hypertensive women were excluded.

Prior to the RCT, an epidemiological and transversal study was developed to collect data on the control and staging of AH. To this end, a sample calculation was carried out based on the 3,041 individuals registered in the 11 research locus units, with the aid of the Epi-infoTM version 7.2 software, with a prevalence of 50%, confidence level of 95%, and sampling error of 5%. The sample of the initial study consisted of 410 people, selected by non-probability sampling.

Of the 410 participants recruited, only individuals with intermediate cardiovascular risk, defined by a Global Risk Score (GRS) between 5% and 20% for men and 5% and 10% for women, and GRS below 5% with a family history of premature cardiovascular disease, were considered as the sample for the RCT¹⁰. After applying the eligibility criteria, 100 participants were randomized to the Intervention (IG) and Control (CG) groups, with the aid of the randomizer program (available at: www.randomizer.org).

At first, a random sequence was generated using a computerized algorithm to form blocks of 10 people. Each participant received a sealed envelope, containing a sequence number that allowed their distribution in the study groups, which was opened by the researcher to maintain the confidentiality of allocation. Blinding of the principal investigator and participants was not possible due to the nature of the intervention implemented. However, to minimize the risk of bias, the statistician responsible for data analysis and outcome evaluation was blinded.

To investigate the primary outcomes, regarding the cardiometabolic and blood pressure profile, a sociodemographic and clinical questionnaire was applied in both groups, exclusively by the researcher, to collect personal and family history of cardiovascular events, including questions related to aspects of hypertensive disease. All participants underwent blood tests, performed by an accredited laboratory, to analyze fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides, and all necessary preexamination orientations were performed.

BP values were measured using an automatic sphygmomanometer according to the technique recommended by the 7th Brazilian Guideline on Hypertension10. The anthropometric measurements, such as weight, height, body mass index (BMI), abdominal circumference (AC), hip circumference (HC), neck circumference (NC), and waist-to-hip ratio (WHR), followed the recommendations of the Food and Nutrition Surveillance System Manual¹¹.

As part of the intervention, nursing consultations based on supported self-care were applied with the participants of the IG. Because it coincided with the period of social isolation caused by Covid-19, deviations from the pre-established protocol were necessary, where the intervention methodology, which initially consisted of five face-to-face consultations, was readapted to the pandemic context, with three face-to-face consultations and three by telephone.

In the first face-to-face consultation with the IG, which lasted an average of one hour and 20 minutes, the first four steps of the Five A’ s Technique concerning: 1) assessment of current health behaviors; 2) counseling; 3) agreement; and 4) assistance in developing an individualized care plan¹²-¹³.

Step five - Follow-up - was implemented from the second nursing visit, aiming to support the process of behavior change, in order to recognize difficult situations early, to manage relapses, and to seek solutions¹². New measurements of anthropometric measurements and BP were taken during the face-to-face meetings. At the end of the intervention, which lasted a total of six months, a survey was conducted about the goals achieved.

During the entire intervention period, the CG did not receive any type of assistance from the researcher, following the usual follow-up by the FHS nurse, which consisted of BP and anthropometric measurements, as well as health guidelines on healthy lifestyle habits performed during routine consultation in the primary care service. After the end of the intervention protocol, both study groups were reassessed for anthropometric and blood pressure parameters, with reapplication of the collection instruments, as well as new laboratory tests.

Data processing and analysis were performed using the Statistical Package for the Social Sciences (SPSS), version 25.0. Descriptive statistics were used, using means, medians, absolute and relative frequencies. The correlation between variables was based on the normality distribution of the data evaluated by the Kolmogorov-Smirnov test, using the student’s t-test and Mann-Whitney test for independent samples and the paired t-test and Wilcoxon test for related samples. For correlation of categorical variables, Pearson’s chisquare test was used. A significance level of p < 0.05 was considered.

The study was approved by the Research Ethics Committee of the HUOC/PROCAPE Hospital Complex with opinion 3.113.712.

RESULTS

One hundred participants classified as intermediate cardiovascular risk were included in the study. However, during the allocation process, 13 individuals were excluded as explained in Figure 1. Thus, 87 participants made up the sample and were randomized into control and intervention groups. During the 6-month follow-up, which coincided with the Covid-19 pandemic period, there were losses in the groups due to change of address and telephone contact, withdrawal from the study and death.

At the end of the RCT, a total of 78 participants completed all phases of the research protocol, distributed as 40 in IG and 38 in CG. The researcher did not report or observe any side effects that could be associated with the intervention developed, given its nature as health education.

Figure 1
Flowchart of allocation and loss of study participants. Cajazeiras, Paraíba, Brazil, 2020

In Table 1, one can see the characteristics corresponding to the participants’ sociodemographic and economic data. Homogeneity between the groups is observed, both with a predominance of females, white, living in a stable union, without profession or occupation, with incomplete elementary education, and income < three minimum wages. There was greater representation of middle-aged adults in the intervention group and of elderly in the control group, with no statistical relevance.

Table 1
Sociodemographic and economic characterization of the study groups; (n= 78). Cajazeiras, Paraíba, Brazil, 2020

VARIABLES	Intervention Group		Control Group	p
	n (%)		n (%)
Age
18 to 39 years old	6 (15.0)		2 (5.3)	0.19
40 to 59 years old	23 (57.5)		15 (39.5)
> 60 years old	11 (27.5)		21 (55.3)
Gender
Female	33 (82.5)		31 (81.6)	0.36
Male	7 (17.5)		7 (18.4)
Color/Race
Black	5 (12.5)		6 (15.8)	0.61
White	22 (55.0)		20 (52.6)
Brown	13 (32.5)		12 (31.6)
Marital Status
Single		4 (10.0)	4 (10.5)	0.83
Living with spouse/partner		27 (67.5)	23 (60.5)
Widow/widower		4 (10.0)	8 (21.1)
Separated		5 (12.5)	3 (7.9)
Profession/Occupation
No profession/occupation		25 (62.5)	26 (68.4)	0.32
Intellectual and scientific workers		0 (0.0)	1 (2.6)
Middle-level professionals		4 (10.0)	2 (5.3)
General service and sales workers		6 (15.0)	6 (15.8)
Industrial and agricultural workers		5 (12.5)	3 (7.9)
Individual income
No income		8 (20.0)	1 (2.6)	0.66
1 to 2 salaries		9 (22.5)	10 (26.3)
2 to 3 incomes		22 (55.0)	26 (68.4)
3 to 4 incomes		1 (2.5)	1 (2.6)
Education
Illiterate		6 (15.0)	3 (7.9)	0.33
Elementary School Complete		1 (2.5)	1 (2.6)
Elementary School incomplete l		17 (42.5)	23 (60.5)
Completed High School		5 (12.5)	5 (13.2)
Incomplete High School		5 (12.5)	1 (2.6)
Higher Education Complete		3 (7.5)	3 (7.9)
Incomplete Higher Education		1 (2.5)	0 (0.0)
Professionalizing course		2 (5.0)	2 (5.3)

Source: survey data, 2020.

The comparison between the nutritional profile, presented in Table 2, shows an improvement in the results of anthropometric variables before and after the nursing consultation applied, pointing to a statistically significant reduction in weight, AC, WHR, and BMI values in the IG. The CG did not undergo changes in the measurements of these variables, maintaining a nutritional profile like that of the initial assessment.

Table 2
Comparative analysis of the nutritional profile of the study groups before and after the intervention; (n= 78). Cajazeiras, Paraíba, Brazil, 2020

VARIABLES	Intervention Group		p	Control Group		p
	Before	After		Before	After
Weight	*69.9 (44-131)	*69.0 (45-114)	0.01	*70.1 (45-117)	*70.4 (46-120)	0.83
Abdominal Circumference	**97.2 ±11.4	**93.3 ±10.7	<0.01	**97.0 ±12.2	**95.8 ±10.7	0.11
Neck Circumference	**35.0 ±3.36	**34.8 ±3.58	0.46	35.5* (31-44)	*35.5 (32-45)	0.15
Waist-to-Rip Ratio	**0.96 ±0.08	**0.92 ±0.08	<0.01	**0.95 ±0.09	**0.94 ±0.09	0.32
Body Mass Index	*27.7 (21-46)	*26.9 (21-41)	<0.01	*28.3 (19-43)	*29.0 (18-39)	0.61

Source: survey data, 2020.Note:
• ^*
  Results presented as median and minimum and maximum range (non-parametric Wilcoxon test).
• ^**
  Results presented as mean and standard deviation (Student’s t-test for paired samples).

Regarding the lipid profile shown in Table 3, no statistical changes were found in IG with the counseling based on the five A’s technique, although a non-significant improvement in LDL, HDL, and triglyceride rates was noticed. At the same time, the CG showed a significant increase in triglyceride values (p= 0.03) and a non-significant worsening (p > 0.05) in total and LDL cholesterol.

Fasting blood glucose (Table 3) increased significantly (p < 0.01) for both groups studied, comparing before and after. The metabolic profile of the participants, represented by insulin resistance, did not show any statistical difference after six months of follow-up in IG. However, in the CG there was a relevant increase in the percentage of individuals with Metabolic Syndrome (MS) (p < 0.01), showing an increase in cardiovascular risk factors for this group.

Table 3
Comparative analysis of lipid, glycemic and metabolic profile of the study groups before and after the intervention; (n= 78). Cajazeiras, Paraíba, Brazil, 2020

VARIABLES	Intervention Group		p	Control Group		p
	Before	After		Before	After
Fasting blood glucose	*78.5 (70-163)	*90.0 (80-130)	<0.01	*79.5 (70-150)	*89.0 (72-139)	<0.01
Total Cholesterol	**156.7 ±32.7	**156.5 ±33.9	0.97	**152.8 ±27.2	**153.9 ±32.2	0.83
Triglycerides	*122.2 (89-258)	*124.5 (74-248)	0.99	**123.8 ±20.0	**141.8 ±32.3	0.03
Cholesterol - LDL	**87.2 ±31.3	**83.3 ±32.0	0.44	*78.5 (32-167)	*82.0 (40-121)	0.82
Cholesterol - HDL	*42.0 (40-54)	*43.0 (40-58)	0.11	*43.0 (33-58)	*44.0 (40-54)	0.12
Metabolic Syndrome***
Presence	7 (17.5)	12 (30.0)	0.18	3 (7.9)	16 (42.1)	0.01
Absence	33 (82.5)	28 (70.0)		35 (92.1)	22 (57.9)

Source: survey data, 2020.Note:
• ^*
  Results presented as median and minimum and maximum range (non-parametric Wilcoxon test).
• ^**
  Results presented as mean and standard deviation (Student’s t-test for paired samples).
• ^***
  Results presented as absolute and relative numbers - N (%).

Data regarding the blood pressure profile, shown in Table 4, showed significant improvement in blood pressure levels in IG at the end of the study, with the percentage of disease control reaching 80.0% compared to 50.0% in the initial phase. This result allowed the reclassification of individuals to a milder stage of the disease (prehypertension stage), zeroing the percentages of stages two and three (more severe forms). On the contrary, in the CG, the blood pressure behavior was upward, with an increase in the percentage of uncontrolled BP, and a significant increase in pulse pressure was also visualized (p < 0.01) during the final evaluation.

Table 4
Blood pressure profile of the intervention and control groups at the time of evaluation before and after follow-up; (n= 78). Cajazeiras, Paraíba, Brazil, 2020

VARIABLES	Intervention Group		p	Control Group		p
	Before	After		Before	After
Blood pressure control
Controlled	20 (50)	32(80)	<0.01*	26 (68.4)	22 (57.9)	0.34*
Not controlled	20 (50)	8 (20)		12 (31.6)	16 (42.1)
Disease stage
Normal	7 (17.5)	8 (20)	0.02	10 (26.3)	4 (10.5)	0.20
Pre-hypertensive	12 (30)	24(60)		19 (50)	19 (50)
Stage I	16 (40)	8 (20)		9 (23.7)	12 (31.6)
Stage II	2 (5)	0 (0)		0 (0)	2 (5.3)
Stage III	3 (7.5)	0 (0)		0 (0)	1 (2.6)
Pulse pressure	¥47.6 ±12.9	¥48.1 ±9.86	0.80	¥44.9 ±12.5	¥49.6 ±11.5	0.01

Source: survey data, 2020.Note:
• ^*
  Pearson’s chi-square test for association of percentages. ǂResults presented as median and minimum and maximum range (nonparametric Wilcoxon test). ¥Results presented as mean and standard deviation (Student’s t-test for paired samples).

DISCUSSION

The data presented show positive effects of the nursing consultation based on supported self-care in relation to the blood pressure and cardiometabolic profiles of hypertensive patients when compared to the usual follow-up performed by nurses in family health units. Statistical analysis points to a reduction in anthropometry of participants with consequent improvement in nutritional profile, although the levels achieved do not reflect a decrease in cardiovascular risk cut-off points.

These results are consistent with reports in the literature, where counseling using the five A’s technique can contribute to an average loss of 5.4 kg in pregnant women, reducing to less than 76% the chances of excessive weight gain during pregnancy (p <0.01) ¹⁴. Benefits were also identified in 35 obese women, who showed statistically significant loss of 2.7 kg, 2.18 cm in waist size, and reduced their BMI by 0.34 points over eight weeks¹⁵. Effectiveness in promoting weight loss was also observed among elderly men with hypertension assisted in primary care¹⁶.

Researchers believe that professional training programs for teaching supported self-care is an opportune way to structure guidelines for changes in overweight through brief and personalized counseling¹⁷. The implementation of the five A’ s in health consultations provides a greater tendency to develop treatment plans around patients’ preferences, less imposition of behaviors, and increased collaborative interactions between nurses, nutritionists, and mental health professionals¹⁸.

As for the lipid profile, the supported self-care did not promote statistical changes in IG. Fasting blood glucose increased in IG during the final evaluation, although it remained within acceptable limits (< 100 mg/dl), an increase also observed in CG. Divergent data indicate that the five A’s technique applied to people with type 2 Diabetes Mellitus significantly reduced the mean glycated hemoglobin by 1.5%, as well as the percentage of total cholesterol, LDL, urea, and glomerular filtration rate (GFR). These findings were considered clinically relevant, interfering with disease prognosis. In the group that did not receive the intervention, most changes were negative, with an increase in weight, WC, total cholesterol and GFR values¹⁹.

Meta-analysis of randomized trials with diabetic patients also ratified the positive effects of chronic disease self-management programs, with a reduction in glycated hemoglobin and systolic blood pressure and contributing to the achievement of improved clinical management strategies when compared to individuals assisted by traditional care, guided by simple guidelines, without systematized techniques, and without the sharing of goals and actions²⁰-²¹.

Regarding the metabolic profile, there was a slight increase in the percentage of MS in IG, however, without statistical relevance. In the CG, there was a significant increase in the presence of MS, with worsening of insulin resistance corroborated by the increase in triglyceride and cholesterol values.

MS has a special particularity in the context of cardiovascular diseases due to its burden of clinical changes related to glucose metabolism, endothelial dysfunction and widespread tissue damage. The prevalence of MS in the population reaches percentages of 46.3%, especially in females and in overweight individuals²¹-²³.

Although the contributions of supported self-care on MS are not yet well explained, a meta-analysis of 48 studies that employed brief counseling and motivational interviewing concluded that there was a 55% increase in the chances of producing satisfactory results compared with traditional interventions (Odds Ratio 1.55; p < 0.01). The effects were found to be durable over the long term for a range of risk factors, including body weight, fasting glucose, HDL-cholesterol, and smoking.²⁴-²⁵

Among the most important results obtained in this research are the effects of supported self-care on the blood pressure profile. After follow-up in IG, there was a significant increase in disease control rates, where 80.0% of patients reached the ideal blood pressure target. The implemented actions shifted individuals from the most severe to the milder stages of the disease.

In the CG, the number of people with uncontrolled blood pressure increased from 31.6% to 42.1%, with a respective increase in the percentage of subjects classified in the most advanced stages. The pulse pressure in this group had a significant increase, increasing the risk of stiffness of the great arteries and coronary artery disease.

The problem of uncontrolled blood pressure emerges as a matter of concern in public health in the country, where literature reviews reveal that the highest rate of BP control corresponds to 57.6%, alternating between 20.0% and 30.7% in patients assisted by the FHS²⁶. The difficult maintenance of BP within the desirable parameters contributes to microvascular changes as early as the diagnosis, leading to accelerated atherosclerosis, reduced elasticity, and reduced vascular regeneration capacity, which is the initial mechanism of almost all cardiovascular complications²⁷.

In view of the data pointed out by the literature, the results found are valuable for demonstrating a substantial impact of self-care supported in the control of hypertensive disease, representing an alternative with resolutive potential on the obstacles in the treatment of the disease and its sequelae in the context of primary care. The data prove to be even more impactful when one evaluates the pandemic context experienced, where even with all the intervening factors related to isolation and social distance, the IG obtained favorable clinical results in most of the variables investigated.

A randomized clinical trial conducted with 60 elderly hypertensive patients in Iran after 12 weeks of a self-management program based on the five A’s model reported a significant increase in self-efficacy and chronic disease management scores, improving blood pressure control¹⁶. It is pertinent to clarify that the increase in hypertension control percentages may also have been influenced by the decrease in weight, BMI, AC, and WHR in the IG, confirming the assertion that a 5% body weight loss can lead to a 20 to 30% decrease in blood pressure levels, even when the BMI remains altered¹⁰.

In short, the counseling of the five A’s has proven effective in helping patients modify risk factors and morbid events, producing relevant evidence in biological, behavioral, and therapeutic aspects²⁵. Health consultations, typically used in care services, take on a new guise, where the patient becomes the main caregiver of his treatment, choosing and making decisions about how to manage his health in the long term and in the context of his life. The professional starts to guide and support the change instead of trying to force it⁸,⁹,²⁵.

The benefits presented do not exclude the limitations of this work, in which the biggest difficulties were related to the recruitment of participants in the initial phases of the research, due to the low demand of hypertensive patients in the health units; the resistance of some individuals to start changing their lifestyle habits; the need to restructure the methodological format of the consultations to adapt to the historical moment of the global pandemic; the loss of participants during this period, who could not be contacted for telephone consultations, and the short follow-up time of the intervention, which lasted only six months.

CONCLUSION

In view of the above, it can be stated that the results presented confirm the hypothesis raised by this study. Supported self-care showed positive effects on the health behaviors of people with hypertension, providing the reduction of anthropometric measurements in IG, and improving the percentage of blood pressure control.

Thus, this study brings subsidies for changes in the way of organizing, planning and implementing nursing care for hypertensive patients followed by the FHS. The establishment of concrete, palpable and realistic therapeutic goals, provided by supported self-care, proved to be a useful and feasible tool that can be implemented in the assistance to the programmed demand, in order to increase the efficiency of health outcomes on the management of hypertension.

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Associate editor: Maria Helena Barbosa

Publication Dates

• Publication in this collection
  19 Sept 2022
• Date of issue
  2022

History

• Received
  14 Sept 2021
• Accepted
  16 Mar 2022