Limits...
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.

Show MeSH

Related in: MedlinePlus

Fig 5 Absolute systolic blood pressure after community nurse led interventions compared with usual care for good quality studies
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Fig 5 Absolute systolic blood pressure after community nurse led interventions compared with usual care for good quality studies

Mentions: Eight studies involved nurse interventions delivered outside of healthcare settings. Locations included the home,32 33 37 50 community centres,24 26 or a choice of both.34 One study was set in the workplace35 and one in a pharmacy.36 Pooled data from four good quality studies26 32 33 34 showed a lower outcome systolic blood pressure in favour of monitoring in the community (weighted mean difference −3.4 mm Hg, 95% confidence interval −6.1 to −0.7; fig 5) and two good quality studies showed greater magnitudes of blood pressure reduction with community monitoring than with usual care: systolic −4.7 mm Hg (−8.3 to −1.2) and diastolic −3.1 mm Hg (−4.8 to −1.3).32 34 Pooling of data from all four studies also showed a greater magnitude of reductions in favour of the intervention: systolic −4.8 mm Hg (−7.0 to −2.7)32 34 36 37 and diastolic −3.5 mm Hg (−4.5 to −2.5).32 34 35 37


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 5 Absolute systolic blood pressure after community nurse led interventions compared with usual care for good quality studies
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Fig 5 Absolute systolic blood pressure after community nurse led interventions compared with usual care for good quality studies
Mentions: Eight studies involved nurse interventions delivered outside of healthcare settings. Locations included the home,32 33 37 50 community centres,24 26 or a choice of both.34 One study was set in the workplace35 and one in a pharmacy.36 Pooled data from four good quality studies26 32 33 34 showed a lower outcome systolic blood pressure in favour of monitoring in the community (weighted mean difference −3.4 mm Hg, 95% confidence interval −6.1 to −0.7; fig 5) and two good quality studies showed greater magnitudes of blood pressure reduction with community monitoring than with usual care: systolic −4.7 mm Hg (−8.3 to −1.2) and diastolic −3.1 mm Hg (−4.8 to −1.3).32 34 Pooling of data from all four studies also showed a greater magnitude of reductions in favour of the intervention: systolic −4.8 mm Hg (−7.0 to −2.7)32 34 36 37 and diastolic −3.5 mm Hg (−4.5 to −2.5).32 34 35 37

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