ORIGINAL ARTICLE

Effect on blood pressure of a continued nursing intervention using chronotherapeutics for adult Chinese hypertensive patients
Xiao-Ying Zang, Jin-Feng Liu, Yan-Fen Chai, Frances Kam Yuet Wong and Yue Zhao

Aims and objectives. (1) To explore the effect of continued nursing intervention on hypertensive patients based on chronotherapeutics. (2) To identify the factors affecting hypertensive patients’ compliance to the chronotherapeutics-oriented nursing interventions. Background. Chronotherapy provides a means of individual treatment for hypertension according to the circadian bloodpressure profile of each patient and constitutes a new option in optimising blood-pressure control and reducing risk from hypertension. Design. Experimental study. Methods. All participants enrolled were randomly divided into the intervention group and the control group and they all took antihypertensive medicine prescribed by their doctors under ambulatory blood pressure monitoring. According to individual ambulatory blood pressure monitoring measures, interventions were implemented. Results. (1) There were significant differences in blood pressure and compliance to chronotherapeutics between the two groups before and after the intervention. (2) Single variant and multiple factors analysis revealed different characteristics influencing chronotherapeutic compliance of hypertensive patients. Conclusions. Under ambulatory blood pressure monitoring, continued nursing intervention for hypertensive patients guided by chronotherapeutics could effectively improve blood-pressure control and chronotherapeutic compliance. Relevance to clinical practice. Health care providers who deal with Chinese hypertensive patients can improve patients’ therapeutic compliance and blood pressure control guided by chronotherapeutics. According to different influencing factors on patients’ chronotherapeutic compliance nurses should pay more attention to those whose compliance might be worse. Key words: ambulatory blood pressure monitoring (ABPM), China, chronotherapeutics, nurses, nursing
Accepted for publication: 30 October 2009

Introduction
Hypertension is a highly prevalent disease and a strong risk factor for cardiovascular disease worldwide (Wolf et al. 1997, Bonow et al. 2002, Chinese guidelines for hypertension prevention and control amending committee 2005). There are many therapeutic and nursing programmes purporting to
Authors: Xiao-Ying Zang, PhD, RN, Teacher, School of Nursing, Tianjin Medical University; Jin-Feng Liu, RN, Teacher, School of Nursing, Shandong University of Traditional Chinese Medicine; YanFen Chai, MD, Professor of Treatment, Emergency Department, General Hospital of Tianjin Medical University, Tianjin; Frances Kam Yuet Wong, PhD, RN, Professor, School of Nursing, Hong

control hypertensive patients’ blood pressure (BP) effectively and to improve their quality of life. However, conventional therapy and nursing have, to date, ignored the chronobiological rhythm of BP. The treatment of diseases has been based on the concept of homeostasis and has not incorporated an understanding of biological rhythms and their underlying mechanisms. Biological rhythms are
Kong Polytechnic University, Hong Kong; Yue Zhao, PhD, RN, Professor, School of Nursing, Tianjin Medical University, Tianjin, China Correspondence: Yue Zhao, Professor, School of Nursing, Tianjin Medical University, Tianjin, China. Telephone: 86 022 23542563. E-mail: yuezhao35@hotmail.com

Ó 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 1149–1156 doi: 10.1111/j.1365-2702.2009.03166.x

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A behaviour that can affect all patients. Chronotherapeutics is advancing hypertension treatments beyond once-daily dosing by synchronising the maximum levels of medication during times when cardiovascular risk is highest. Patients with over one-year primary hypertensive history and with medicine treatment were included. Using novel oral delivery methods. Nocturnal hypertension increases risk of cardiovascular and cerebrovascular events. Methods Participants The medical ethics committee of the General Hospital of Tianjin Medical University approved our study and written informed consent was obtained from all participants. Normalisation of the circadian blood-pressure pattern is considered an important clinical goal of pharmacotherapy because it may slow the advance of renal injury (Hermida et al. non-compliance is perplexing 1150 because it remains largely unrecognised in clinical practice (Burnier 2000). especially important. Failure to recognise the circadian decline in BP may result in iatrogenic chronopathological events. From October 2006–December 2006. Journal of Clinical Nursing. On the basis of previous data (Chinese guidelines for hypertension prevention and control amending committee 2005) and our pilot study with ten participants (average SBP: 150Æ8. nearly 70% of patients do not have their hypertension adequately controlled. ‘Hypertension’ was defined as systolic BP (SBP) ‡140 mmHg. we estimated the sample size of two groups should be 60. education level. Therefore. living with relatives. chronotherapeutic medication synchronises the delivery of BP drugs within the period of risk. financial burden. the rate of BP increase. In this study. Chronotherapeutics is the purposeful alteration of drug levels to match rhythms to optimise therapeutic outcomes and minimise size effects. payment for medical care. or being on antihypertensive medications (actual or self-reported) regardless of BP measurements (Chinese guidelines for hypertension prevention and control amending committee 2005). ‘Normtension’ was defined as BP < 140/90 mmHg and not taking antihypertensive medication. nephrosclerosis and progression to end-stage kidney failure in renal patients. this may contribute to the increase of acute cardiovascular events that peak in the morning hours. diastolic BP (DBP) ‡90 mmHg. whether with family history. For the treatment of hypertension. we could explore the factors influencing patients’ compliance. we aimed to unite one ABPM measure and repeated home BP measurements in hypertensive patients and develop a continued nursing intervention plan based on chronotherapeutics to influence their ways of taking medicine and lifestyle for three months. 2005). source of finance. SD 13Æ81). course of hypertension. This was then evaluated to provide the basis for designing the best interventions to improve hypertensive patients’ compliance to treatment and BP control. including the circadian cycle (Martin 2004). Despite improvements in the management of hypertension in recent years and the numerous efficacious antihypertensive agents available to today’s physician. this idea has the potential for a therapeutic paradigm shift (Prisant 2001). etc. constitutes a new option in optimising BP control and reducing risk. implicated in cardiovascular events. BP exhibits strong circadian variation. gender. Ó 2010 Blackwell Publishing Ltd. Knapp said that hypertensive patients with progressive kidney deterioration might be a consequence of little or no fall in sleeping BP. occupation. significantly reducing both absolute BP and. 1149–1156 . the patients who came to see a doctor in the medical clinic of the General Hospital were asked to participate. Instruments A sociodemographic questionnaire was used including age. Recently. These therapies have also shown the ability to maintain adequate BP levels during the trough period (Prisant 2004).X-Y Zang et al. He urged clinicians and clinical trialists to be more thoughtful about the time of administration of drugs in relation to biological rhythms. considering those lost to follow-up we determined to include 72 participants. 19. The development of ambulatory blood pressure monitoring (ABPM) and the rapidly growing popularity of home BP measurements by patients have generated a series of new clinical questions that are directly linked to the chronobiology of the cardiovascular system (Hassler & Burnier 2005). including anterior ischaemic optic neuropathy and cerebrovascular accidents. chronotherapy provides a means of individualising treatment of hypertension according to the circadian BP profile of each patient. In the meantime. whether smoking or drinking or suffering from diabetes or coronary heart disease. Reducing morning BP may prevent these occurrences (Weber & Fodera 2004). Non-compliance with prescribed regimens appears to be one of the primary contributors to the large numbers of patients with uncontrolled hypertension. monthly income. continued nursing intervention for hypertensive patients based on chronotherapeutics adapts to the development of nursing programmes for hypertensive patients and may help implement intervention for diseases with circadian rhythms. marital status. The patients with secondary hypertension or mental diseases or other severe somatic diseases were excluded.

we would implement interventions on BP monitoring. taking medicine. SpaceLabs Inc. 2006). and in the end. 2002). 133 participants were included to complete the CCQH to test its reliability and validity in our pilot study. two and three months after the participants were enroled. To explore the influencing factors of chronotherapeutic compliance of hypertensive patients. After principal component analysis with varimax orthogonal rotation. Intervention programme All participants enroled were randomly divided into either the intervention group or the control group. etc. 10 AM . Kaiser–Meyer– Olkin (KMO) measure and Barlett’s test were used first. advising them to change bad lifestyles such as reducing physical activities when BP was rising. 19. 7–8 AM . All of them were randomly divided into two groups: the intervention group and the control group. Issaquah. Cronbach’s a coefficient was 0Æ90 which meant the reliability was high. 72 hypertensive patients participated in the following study. They all took antihypertensive medicine prescribed by their doctors under ABPM. exercise. USA) was used. time prone to complications and their relationship with chronobiological rhythm. attitude and practice and according to chronotherapeutic theory. The intervention group participants were visited by the interviewers the first time within one week of the beginning of the study. diet and restriction of cigarettes and alcohol. The interviewers presented them with the manual of primary hypertension Results Comparison of intervention group and control group demographics Seventy-four patients participated and two quitted because of moving house. procedural checklists and data review (Yan et al.Original article Effect on blood pressure of a continued nursing intervention using chronotherapeutics Under the model of knowledge. Student t-test was used to examine the differences of age between the control and intervention group and chi square test to assess other sociodemographic data between two groups. to make them realise the indication. that is to say the internal consistency of the questionnaire was good. time of taking medicine. univariate analysis and logistic regression were performed. Quality control was assured by technician recertification. Chicago. The main intervention contents were as follows: the cognition interventions included helping participants to know the risk and inducing factors of hypertension. WA. Home BP measurement was collected on the second day. Differences between two groups’ preintervention BP and compliance to CCQH measurements were examined using t-test and repeated variant analysis was performed to test data of BP on the end of one. Data analysis For database management and statistical analysis. 12 N–1 PM . SPSS 13. etc. 1149–1156 . IL. 4–6 PM and bedtime (Jie 2005). Five professionals assessed the content validity and considered that the items and content of the questionnaire indicated most of the treatment concepts of the primary hypertension and the theory of chronotherapeutics. On the basis that the number of the participants should be threefive times the number of the items in the questionnaire (Minglong 2000). Behaviour interventions included instructing participants to obey the types and doses of medicine and adjust the time of taking medicine according to chronotherapeutics. Exploratory factor analysis was used to test construct validity. Journal of Clinical Nursing. nursing based on chronotherapeutics and continued nursing intervention plan and explained the contents to them in detail. two and three months. USA). exercise. 2006). diet. The six factors interpreted the cumulative variation of 75Æ6% and the structure of the questionnaire coincided with the initial hypothesis. The psychological interventions included helping participants accommodate their mode to avoid the fluctuation of BP. Twenty-four hour ABPM was carried out on the nondominant arm using an oscillometric device (Spacelabs 90207. Home BP measurement was measured at getting-up. According to individual ABPM measurements. time of taking medicine. The device was set to obtain BP readings every 20 minutes during daytime (8 AM –10 PM ) and every 45 minutes during night-time (10 PM –8 AM ) (Yan et al. 1151 Ó 2010 Blackwell Publishing Ltd. six common factors were extracted which were compliance to BP monitoring. etc. The KMO result was 0Æ679 and the v2 value of Bartlett’s test was 6419Æ481 and the significance was <0Æ001 indicating that the questionnaire was appropriate for factor analysis. the seven-day recall Chronotherapeutic Compliance Questionnaire for hyperpietic (seven-day recall CCQH) was developed based on the questionnaire of Xiao Huimin.0 (SPSS Inc. restriction of cigarettes and alcohol. taking medicine. (Huimin et al. the end of one. There were no statistical differences between two groups in the main sociodemographic characteristics of the study participants. especially when the pressure was rising according to individual BP rhythm. Trained interviewers asked participants to complete the questionnaires with identical words and the interviewers would tell the participants how to apply home BP measurement correctly. giving the plan for an anti-hypertensive diet and quitting cigarettes and alcohol. etc..

while in the control group. age. payment of medical care and whether intervention had statistical significances (Table 3). The reason may be as Ó 2010 Blackwell Publishing Ltd. 1152 Blood pressure monitoring Before 13Æ4 ± 1Æ56 12Æ8 After 17Æ2 ± 1Æ77 13Æ6 Difference 3Æ8 ± 1Æ03 0Æ8 Time of taking medicine Before 11Æ1 ± 2Æ18 10Æ8 After 14Æ7 ± 2Æ39 12Æ1 Difference 3Æ6 ± 1Æ07 1Æ3 Taking medicine Before 11Æ6 ± 1Æ97 12Æ0 After 14Æ6 ± 2Æ33 13Æ1 Difference 3Æ0 ± 1Æ12 1Æ1 Diet Before 11Æ5 ± 2Æ24 11Æ2 After 15Æ2 ± 2Æ11 12Æ5 Difference 3Æ7 ± 1Æ23 1Æ3 Exercise Before 8Æ6 ± 1Æ88 8Æ2 After 11Æ4 ± 2Æ27 9Æ1 Difference 2Æ8 ± 1Æ47 0Æ9 Restriction of cigarettes and alcohol Before 13Æ0 ± 2Æ64 13Æ7 After 14Æ1 ± 2Æ59 14Æ2 Difference 1Æ1 ± 1Æ09 0Æ5 Total Before 78Æ1 ± 6Æ26 77Æ8 After 90Æ8 ± 5Æ14 82Æ3 Difference 12Æ7 ± 4Æ25 4Æ5 ± 1Æ91 ± 1Æ85 ± 0Æ61 ± 2Æ38 ± 2Æ11 ± 0Æ88 ± 2Æ29 ± 2Æ29 ± 0Æ97 ± 1Æ97 ± 1Æ28 ± 0Æ79 ± 1Æ14 ± 1Æ28 ± 0Æ75 ± 2Æ11 ± 1Æ94 ± 0Æ56 ± 7Æ11 ± 5Æ48 ± 2Æ43 1Æ256 7Æ569 1Æ249 2Æ524 À0Æ065 3Æ508 1Æ617 2Æ718 1Æ396 3Æ948 À0Æ182 0Æ398 1Æ218 4Æ469 0Æ213 0Æ000** 0Æ216 0Æ016* 0Æ948 0Æ001** 0Æ106 0Æ008** 0Æ163 0Æ000** 0Æ856 0Æ693 0Æ207 0Æ000** CCQH. family member living together. except age.and postintervention-BP measurements We used a t-test to assess the differences of home BP measurements between two groups before intervention. All these variates were tested by multiple variants logistic regression analysis. 82Æ2 was seen as a cut-off and the difference between urban and rural areas. repeated variant analysis showed there were significant differences of threemonth sequential monitoring after intervention (Table 1).and postintervention-compliance of CCQH measurements The results of t-test showed no difference of the six dimensions of CCQH between two groups before intervention. education level. there were differences in other five dimensions which meant the intervention was effective (Table 2). occupation. marital status. Preintervention. we saw that both groups of participants’ BP were controlled steadily at the end of the first month and the stability of intervention group could maintain. which suggested our interventions based on chronotherapeutics were effective. mean diastolic blood pressure. Table 1 MSBP and MDBP of control and intervention groups The end of one month 125Æ3 123Æ5 81Æ6 81Æ0 ± ± ± ± 2Æ76 3Æ12 1Æ99 1Æ72 The end of two months 131Æ3 131Æ3 85Æ7 82Æ6 ± ± ± ± 4Æ31 3Æ75 2Æ52 2Æ28 The end of three months 139Æ2 131Æ1 89Æ4 82Æ5 ± ± ± ± 3Æ27 2Æ93 1Æ45 1Æ41 Group Control group MSBP Intervention group MSBP Control group MDBP Intervention group MDBP Beginning 158Æ6 ± 20Æ83 152Æ5 ± 12Æ25 88Æ3 ± 8Æ42 87Æ5 ± 7Æ69 p 0Æ485 0Æ195 p 0Æ004 0Æ016 MSBP. 19. time of diagnosis. and the results indicated there were no differences in the mean systolic and diastolic pressure. marital status. 1149–1156 . However. occupation and time of diagnosis. The mean of all participants’ compliance score. Journal of Clinical Nursing.X-Y Zang et al. there were significant differences between the intervention and the control group’s BP. *p < 0Æ05. Discussion Through our intervention of three months. Factors influencing the total value of chronotherapeutic compliance Single variant analysis was performed to analyse the factors influencing the total value of chronotherapeutic compliance of different characteristic hypertensive participants. From the data. the other six factors were still statistically significantly different (Table 4). but after intervention only except restriction of cigarettes and alcohol. mean systolic blood pressure. **p < 0Æ01. MDBP. Table 2 Two groups’ compliance of each dimension of CCQH before and after intervention ±s x Intervention (n = 36) Control (n = 36) Item t p Preintervention. monthly income of family. the stability faded away with time and disappeared by the end of the second month. Chronotherapeutic Compliance Questionnaire for hyperpietic.

(0Æ66. Therefore. 1149–1156 . time prone to complications and their relationship to chronobiological rhythm. These interventions could help participants avoid some complications of hypertension 1153 Ó 2010 Blackwell Publishing Ltd. 1Æ86) 1Æ48 (1Æ16. 18Æ15) 4Æ574 8Æ839 10Æ687 5Æ612 0Æ032* 0Æ003** 0Æ001** 0Æ018* 0Æ000 1Æ114 1Æ431 0Æ622 0Æ379 0Æ387 0Æ563 1Æ00 3Æ04 (1Æ45. 5Æ93) 10Æ12 (3Æ56. 9Æ37) 1Æ92) 22Æ63) 2Æ14) 1Æ86) v2 5Æ247 9Æ657 0Æ244 3Æ116 0Æ089 p 0Æ019* 0Æ002** 0Æ621 0Æ078 0Æ766 0Æ234 0Æ469 1Æ00 2Æ29 (1Æ55. they could avoid these risk factors in their daily activity and take measures in time to prevent complications. especially when the pressure was rising according to individual BP rhythm. Journal of Clinical Nursing. 4Æ78) 1Æ20 (0Æ54. 1Æ89) 1Æ18 (1Æ09. 3Æ29) 5Æ42 (1Æ26. Our psychological interventions helped participants accommodate their mood to avoid the fluctuation of BP. (0Æ83. 1 = F) Nationality (0 = Han. b 1Æ050 0Æ115 0Æ628 0Æ077 0Æ246 0Æ000 1Æ091 2Æ135 SE 0Æ439 0Æ063 1Æ272 0Æ054 0Æ045 OR (95%CI) 2Æ33 1Æ12 1Æ88 1Æ19 1Æ09 (1Æ45. **p < 0Æ01. 3Æ08) 1Æ24 (0Æ82. 1Æ27) 8Æ839 18Æ830 25Æ349 17Æ862 0Æ003** 0Æ000** 0Æ000** 0Æ000** 0Æ674 0Æ784 0Æ124 0Æ039 4Æ409 1Æ859 10Æ088 10Æ136 17Æ445 0Æ038* 0Æ173 0Æ001** 0Æ000** 0Æ000** follows: we helped participants know the risk and inducing factors for hypertension and made them realise the indication. etc. 1 = yes) Education level Elementary Junior Senior v2 (df = 2) Marital status Widowed Single Divorced Married v2 (df = 3) Living with relatives Alone Nursery maid Children Spouse v2 (df = 3) Occupation Farmer Workman Cadre Other v2 (df = 3) Source of finance In service Pension Folks Others v2 (df = 3) Monthly income Low Middle High v2 (df = 2) Time of diagnosis Payment of medical care Own expenses Medicare Cooperative medical care Insurance v2 (df = 3) Whether intervention *p < 0Æ05. 23Æ37) 0Æ279 1Æ964 14Æ405 14Æ211 0Æ611 0Æ371 0Æ000** 0Æ003** 0Æ000 0Æ529 1Æ074 2Æ874 0Æ246 0Æ361 0Æ557 1Æ00 1Æ69 (1Æ05. 4Æ91) 1Æ67 (0Æ78. 28Æ79) 13Æ66 (4Æ06. 19. 3Æ86) 1Æ764 1Æ687 1Æ954 0Æ916 0Æ174 0Æ192 0Æ135 0Æ339 0Æ000 1Æ074 2Æ315 2Æ615 0Æ000 1Æ217 1Æ063 0Æ395 0Æ163 0Æ361 0Æ533 0Æ619 1Æ00 2Æ93 (1Æ44. 7Æ36) 6Æ51 (2Æ32. 3Æ15) 1Æ75 (0Æ79. 2Æ74) 2Æ93 (1Æ44. (1Æ08. 5Æ13) 8Æ655 15Æ244 2Æ732 9Æ963 0Æ003** 0Æ000** 0Æ093 0Æ002** 0Æ000 0Æ613 0Æ484 0Æ468 1Æ484 0Æ373 0Æ476 1Æ00 1Æ90 (0Æ74. 1 = urban) Age Gender (0 = M. 6Æ40) 4Æ37 (1Æ98. 1 = minority) Faith (0 = no.Original article Effect on blood pressure of a continued nursing intervention using chronotherapeutics Table 3 Single variate analysis of factors interfering total value of chronotherapeutic compliance of hypertensive patients Variable Difference (0 = rural. 45Æ92) 1Æ00 2Æ43 (1Æ92. 18Æ40) 10Æ258 15Æ671 19Æ052 0Æ000** 0Æ000** 0Æ000** 0Æ000 0Æ674 0Æ248 1Æ669 0Æ325 0Æ145 0Æ381 1Æ00 1Æ86 (0Æ81. 8Æ31) 1Æ54 (0Æ37. (0Æ46. 5Æ93) 6Æ17 (2Æ08.

(1Æ43. 2003). 1997). The role of ambulatory measurement in guiding drug treatment is the subject of many researches and its role in this regard has not been fully established (O’Brien et al. 19. therefore they could accept this more easily. ABPM provides information about BP during daily activities and sleep. three common methods of monitoring BP. The control group’s compliance to BP monitoring. after time. They could also change their lifestyles such as reducing physical activities according to chronotherapeutics. 1 = urban) Age Education level Marital status Living with relatives Occupation Monthly income Time of diagnosis Payment of medical care Whether intervention *p < 0Æ05.g. 1999). 2003). this could help to make ABPM and home self-monitoring complementary and constitute a nursing programme for hypertensive patients based on individual’s chronobiological rhythm. 2000). 2008). On the basis of chronotherapeutics. such as clinic BP. and thereby control BP better. Thus. in our study. (1Æ26. Mallion et al. one month) participants would be compliant to doctors’ prescription and the medicine could control BP. We used the mean BP of six measurements of home self-monitoring as a participant’s BP (Chatellier et al. taking medicine and lifestyle lowered. time of taking medicine. (1Æ19. 1149–1156 . a well-controlled study showed that when ambulatory measurement rather than measurement in a clinic was used as the basis for prescribing treatment. The intervention group patients received a comprehensive discharge planning and home follow-up protocol designed specifically for elders at risk of poor outcomes after discharge and implemented by advanced practice nurses. participants understood the influence of BP fluctuation and the importance of home BP self-monitoring. BP has a reproducible circadian profile. Journal of Clinical Nursing. 1996) to make sure this home self-monitoring was similar to ABPM. lengthened the time between discharge and readmission and decreased the costs of providing health care. participants could take their medicine before BP rose to avoid its fluctuation. (2Æ56. (0Æ54. (0Æ78. doctors could adjust the time of taking medicine according to the most effective time of medicines Ó 2010 Blackwell Publishing Ltd. Self-monitoring of BP at home and work is a practical 1154 approach to assess differences between office and out-of office BP prior to the consideration of ambulatory monitoring (Zhu et al. Furthermore. (0Æ95. but its veracity is compromised by the ‘white-coat effect’ (Selenta et al. 8Æ59) 4Æ17) 6Æ29) 1Æ91) 5Æ94) 4Æ86) 8Æ15) 4Æ51) 10Æ35) 2Æ22) v2 3Æ917 2Æ697 10Æ964 1Æ547 6Æ643 0Æ853 21Æ139 3Æ544 6Æ934 9Æ345 p 0Æ044* 0Æ102 0Æ001** 0Æ231 0Æ011* 0Æ427 0Æ000** 0Æ061 0Æ011* 0Æ002** and control BP effectively. we could see the priority of the intervention in improving BP. Each monitoring method has its advantages and disadvantages. However. (1Æ54. Under our behaviour interventions. which could explain the instability of their BP. with higher values while awake and mentally and physically active. The result showed an advanced practice nurse-centred discharge planning and home care intervention for at-risk hospitalised elders reduced readmissions. (0Æ54. 2000. Therefore. b 1Æ081 0Æ674 1Æ154 0Æ287 1Æ005 0Æ583 1Æ514 0Æ915 1Æ076 0Æ485 SE 0Æ546 0Æ416 0Æ349 0Æ121 0Æ498 0Æ456 0Æ529 0Æ505 0Æ648 0Æ159 OR (95%CI) 2Æ95 1Æ96 3Æ17 1Æ18 2Æ73 1Æ45 4Æ50 2Æ61 2Æ98 1Æ62 (1Æ01. Naylor et al. recent reviews of the clinical value of ambulatory measurement have highlighted the potential usefulness of 24-hour recordings of BP in guiding drug treatment (White 1998. The accurate measurement of BP is the sine qua non for successful management (Chobanian et al. And we also found that BP of both the intervention and the control group participants were controlled steadily at the end of the first month and the stability of intervention group was maintained while in the control group the stability faded with time and disappeared by the end of the second month. In recent studies. Zhu et al. Under our intervention. Clinic BP is often used in clinical diagnosis. much lower values during rest and sleep and early morning increases for three or more hours during the transition of sleep to wakefulness (Kario et al. 2008). the intervention demonstrated great potential in promoting positive outcomes for hospitalised elders at high risk for rehospitalisation while reducing costs. we combined ABPM and home BP self-monitoring not only to find out the characteristic of each participant’s individual BP but to avoid the limitation of finance so as to form a monitoring system based on home self-monitoring. significantly less antihypertensive drug treatment was prescribed (Staessen et al.X-Y Zang et al. Therefore. The reason may be in a short time (e. However. home BP and ABPM have been used. Table 4 Multiple variants logistic regression analysis of factors interfering total value of chronotherapeutic compliance of hypertensive patients Variable Difference (0 = rural. (1999) examined the effectiveness of an advanced practice nurse-centred discharge planning and home follow-up intervention for elders at risk for hospital readmissions. **p < 0Æ01.

family member living together. After intervention. which may be limited by patients’ financial situation. Patients with higher education level found it easier to understand and accept new knowledge about chronotherapeutics. in descending order were spouse. non-compliance to hypertension medication is a major problem. having knowledge about hypertension can offer a hypertensive patient more chances and ways to know about hypertension and care himself/herself. In developing countries. they knew they had to limit salt intake but they had no idea by how much. therefore health care providers should take different measures to improve compliance according to patients’ different characteristics. children. we made the participants aware of different effects and characteristics of different medicines and asked them to keep strictly to the time of taking medicine. The cost of ABPM was not included in hospitalisation insurance now in China. Education level was another influencing factor. The reason may be that it is hard and timeconsuming for smokers and drinkers to quit or restrict their habits. The results showed the compliance to time of taking medicine of the intervention group improved while there was no difference in the control group before and after the study. Differences between urban and rural areas. nursery maid and single. the participants improved their bad habits significantly in diet (especially in limit of salt taking) and exercise. Nursing intervention is aimed at educating people to form good habits and lifestyle and to lower or extinguish the risk factors affecting well-being. 1149–1156 . Conclusions On the basis of ABPM. Monthly income of family and payment for medical care were also influencing factors. Chronotherapeutic treatment and nursing rely on patients’ ABPM. In our study. or. monthly income of family. continuous intervention on hypertensive patients guided by chronotherapeutics could effectively improve therapeutic compliance and blood-pressure control. we made the intervention group understand the relationship between hypertension and stroke. We know correct measurement is necessary for treating hypertension successfully and home BP measurement may depend on family members’ help and supervision. unaffordable drug prices appear to be the major cause (Ohene et al. we developed the seven-day recall CCQH in Chinese and its reliability and validity were only evaluated in China. In future. it could be translated into English and other languages and be tested through international cooperation. Limitations In this study. Although long-effect medicines have the virtue of longer action and less times of taking.. Journal of Clinical Nursing. Therefore. we instructed the poorer participants to take the medicine of lower price on the basis of chronotherapeutic theory. Relevance to clinical practice Health care providers who deal with Chinese hypertensive patients can improve patients’ therapeutic compliance and 1155 Ó 2010 Blackwell Publishing Ltd. We found that many primary hypertensive patients did not know the relationship between dietary salt intake and hypertension. which. Family member living together was also an influencing factor. the score of compliance to taking medicine of the intervention group increased significantly but not in the control group. payment of medical care and whether intervention were the influencing factors of hypertensive patients’ compliance to chronotherapeutics. and their chronotherapeutic compliance might be better. Therefore patients with worse financial status found it difficult to accept ABPM as a means of monitoring BP.Original article Effect on blood pressure of a continued nursing intervention using chronotherapeutics and the peak value of BP so as to control morning BP surge.. we can make use of these in our future interventions to promote patients’ compliance. After intervention. which can improve the compliance to taking medicine. which indicated improving patient’s perceiving attitudes could enhance their self-care and enhance their lifestyle. education level. In our study. the study showed no difference in restriction or quitting cigarettes and alcohol before and after the intervention. Treating hypertension is a long process and the compliance to taking medicine is extremely important. Patients living together with their spouse might find it easier to communicate and accept the supervision than those with children or nursery maid. which indicates we should maintain the intervention so as to change these habits and lower the complications and mortality. etc. Therapeutic theory has only been carried out recently with the use of ABPM in China and ABPM is only applied in advanced hospitals and limited by the financial status of the patients. which could also achieve the intention to elevate the compliance. From our study. 2004). heart failure and renal failure. 19. the relationship between nocturnal hypertension and organ damage. they have a higher price. Under our intervention. Therefore. Different members living together could affect the value of compliance. patients with lower education level should be the key population for intervention. However. let them know that compliance to doctor’s prescription could control BP effectively and lessen the adverse effects of the medicine and the fear feelings caused by them. etc. we could see that the difference between urban and rural areas was one of the factors affecting chronotherapeutic compliance. etc.

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