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Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis.

Clark CE, Smith LF, Taylor RS, Campbell JL - BMJ (2010)

Bottom Line: Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken.Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5).Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings.

View Article: PubMed Central - PubMed

Affiliation: Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, St Luke's Campus, Exeter EX1 2LU. christopher.clark@pms.ac.uk

ABSTRACT

Objective: To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study.

Design: Systematic review and meta-analysis.

Data sources: Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database.

Study selection: Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults.

Data extraction: Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken.

Data synthesis: Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5).

Conclusions: Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.

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Fig 3 Changes in blood pressure with interventions including nurse prescribing compared with usual care
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fig3: Fig 3 Changes in blood pressure with interventions including nurse prescribing compared with usual care

Mentions: Two good quality studies30 40 showed greater magnitudes of blood pressure reductions for nurse prescribing than for usual care: weighted mean difference, systolic −9.7 mm Hg (95% confidence interval −14.0 to −5.4) and diastolic −4.3 mm Hg (−7.4 to −1.2). Pooling of all studies showed similar reductions: systolic −8.9 mm Hg (−12.5 to −5.3) and diastolic −4.0 mm Hg (−5.3 to −2.7; fig 3).


Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis.

Clark CE, Smith LF, Taylor RS, Campbell JL - BMJ (2010)

Fig 3 Changes in blood pressure with interventions including nurse prescribing compared with usual care
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2926309&req=5

fig3: Fig 3 Changes in blood pressure with interventions including nurse prescribing compared with usual care
Mentions: Two good quality studies30 40 showed greater magnitudes of blood pressure reductions for nurse prescribing than for usual care: weighted mean difference, systolic −9.7 mm Hg (95% confidence interval −14.0 to −5.4) and diastolic −4.3 mm Hg (−7.4 to −1.2). Pooling of all studies showed similar reductions: systolic −8.9 mm Hg (−12.5 to −5.3) and diastolic −4.0 mm Hg (−5.3 to −2.7; fig 3).

Bottom Line: Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken.Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5).Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings.

View Article: PubMed Central - PubMed

Affiliation: Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, St Luke's Campus, Exeter EX1 2LU. christopher.clark@pms.ac.uk

ABSTRACT

Objective: To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study.

Design: Systematic review and meta-analysis.

Data sources: Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database.

Study selection: Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults.

Data extraction: Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken.

Data synthesis: Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5).

Conclusions: Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.

Show MeSH
Related in: MedlinePlus