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Meta-Analysis
. 2024 Apr 27;25(1):143.
doi: 10.1186/s12875-024-02380-x.

The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis

Masami Ito  1 , Aran Tajika  1 , Rie Toyomoto  1 , Hissei Imai  1 , Masatsugu Sakata  1 , Yukiko Honda  2   3 , Sanae Kishimoto  1 , Memori Fukuda  4 , Noboru Horinouchi  1   5 , Ethan Sahker  1   6 , Toshi A Furukawa  7
Affiliations
Meta-Analysis

The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis

Masami Ito et al. BMC Prim Care. .

Abstract

Background: Previous systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions.

Methods: We conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality.

Results: We included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible.

Conclusions: Nurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.

Keywords: Health education; Hypertension; Nurse; Nurse-led intervention; Nursing care; Nursing intervention; Patient care management; Primary care; Systematic review.

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Conflict of interest statement

AT has received lecture fees from Sumitomo Dainippon Pharma, Eisai, Janssen Pharmaceutical, Meiji-Seika Pharma, Mitsubishi Tanabe Pharma, Otsuka, and Takeda Pharmaceutical. HI received honoraria for lectures from Otsuka Pharmaceutical. MS reports personal fees from SONY outside the submitted work. MF is employees of Aillis, Inc., outside the submitted work. TAF reports grants and personal fees from Mitsubishi-Tanabe, personal fees from SONY, grants and personal fees from Shionogi, outside the submitted work; In addition, TAF has a patent 2020-548587 concerning smartphone CBT apps pending, and intellectual properties for Kokoro-app licensed to Mitsubishi-Tanabe. All the other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Forest plot of the achievement of BP control goals at long term (including the numeric data of the achievement of BP goals compared with usual care)
Fig. 3
Fig. 3
a Forest plot of total mortality at long term. b Forest plot of total mortality at short term
Fig. 4
Fig. 4
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies about the primary outcome
See this image and copyright information in PMC

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