Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension: A Meta-Analysis

Abstract

Background: Globally, only 13.8% of patients with hypertension have their blood pressure (BP) controlled. Trials testing interventions to overcome barriers to BP control have produced mixed results. Type of health care professional delivering the intervention may play an important role in intervention success. The goal of this meta-analysis is to determine which health care professionals are most effective at delivering BP reduction interventions.

Methods: We searched Medline and Embase (until December 2023) for randomized controlled trials of interventions targeting barriers to hypertension control reporting who led intervention delivery. One hundred articles worldwide with 116 comparisons and 90 474 participants with hypertension were included. Trials were grouped by health care professional, and the effects of the intervention on systolic and diastolic BP were combined using random effects models and generalized estimating equations.

Results: Pharmacist-led interventions , community health worker-led interventions, and health educator-led interventions resulted in the greatest systolic BP reductions of -7.3 (95% CI, -9.1 to -5.6), -7.1 (95% CI, -10.8 to -3.4), and -5.2 (95% CI, -7.8 to -2.6) mm Hg, respectively. Interventions led by multiple health care professionals, nurses, and physicians also resulted in significant systolic BP reductions of -4.2 (95% CI, -6.1 to -2.4), -3.0 (95% CI, -4.2 to -1.9), and -2.4 (95% CI, -3.4 to -1.5) mm Hg, respectively. Similarly, the greatest diastolic BP reductions were -3.9 (95% CI, -5.2 to -2.5) mm Hg for pharmacist-led and -3.7 (95% CI, -6.6 to -0.8) mm Hg for community health worker-led interventions. In pairwise comparisons, pharmacist were significantly more effective than multiple health care professionals, nurses, and physicians at delivering interventions.

Conclusions: Pharmacists and community health workers are most effective at leading BP intervention implementation and should be prioritized in future hypertension control efforts.

Keywords: blood pressure; cardiovascular diseases; health personnel; hypertension; risk factors.

Figure 1.. Flowchart of Study Selection

BP – blood pressure

Figure 2.. Mean Net Systolic Blood Pressure Reduction and 95% Confidence Intervals by Healthcare Professional

(A) Pharmacist, (B) Community Health Worker, (C) Health Educator, (D) Multiple Healthcare Professionals, (E) Nurse, and (F) Physician

Figure 3.. Mean Net Diastolic Blood Pressure Reduction and 95% Confidence Intervals by Healthcare Professional

(A) Pharmacist, (B) Community Health Worker, (C) Health Educator, (D) Multiple Healthcare Professionals, (E) Nurse, and (F) Physician

Figure 4.. Adjusted Mean Net Systolic (A) and Diastolic (B) Blood Pressure Reduction Associated with Healthcare Professional Delivering the Intervention

BP – blood pressure Adjusted for sex, age, baseline BP, trial duration, type of control group, and other healthcare professional categories. Boxes are weighted by sample size.