Allied health professional-led interventions for improving control of blood pressure in patients with hypertension: A Cochrane systematic review and meta-analysis
Nurse or pharmacist-led care may improve control of hypertension. We have undertaken a new Cochrane review of evidence for allied health professional led interventions in the management of hypertension.The approach We searched multiple bibliographic databases to October 2013 for randomised controlled trials. We included any nursing, pharmacist, or allied health professional-led intervention designed to improve control of blood pressure, compared to usual management of hypertension.Primary outcome measures were change in systolic blood pressure, achievement of study target blood pressure and use of antihypertensive medication. Two authors independently assessed studies for inclusion, extracted data, and assessed risk of bias using Cochrane criteria. Intervention effects were pooled using odds ratios (OR) or mean differences (MD).
We identified 579 potential unique citations; 234 full-texts were assessed, and 98 papers met the inclusion criteria. Overall, half the risk of bias judgments across studies were rated as low risk.Compared to usual care, greater falls in systolic blood pressure were seen for both nurse-led interventions (MD -3.8mmHg (95% CI: -5.6 to -2.0); 28 studies, 10573 participants) and pharmacist-led interventions (MD -7.6mmHg (-9.7 to -5.4); 30 studies, 6504 participants, p<0.01 for difference). Nurse-led interventions (OR 1.5 (1.3 to 1.7); 24 studies, 15833 participants) and pharmacist-led interventions (OR 3.5 (2.7 to 4.4); 24 studies, 4443 participants) attained higher achievement of study blood pressure targets (p<0.001 for difference between professions), and greater use of antihypertensive medication (nurse-led OR 1.4 (1.1 to 1.7) vs. pharmacist-led OR 2.2 (1.3 to 3.7); p=0.02).Interventions empowering nurses or pharmacists to prescribe or alter antihypertensive medication achieved greater reductions in systolic blood pressure (MD -6.7mmHg (-8.2 to -5.3) vs. -3.9mmHg (-6.7 to -1.1); p=0.08) and greater achievement of study blood pressure targets (OR 2.5 (2.0 to 3.2) vs. 1.7 (1.3 to 2.1); p<0.01) when compared to doctor-led medication management.
Nurse and pharmacist-led interventions are more likely to lower blood pressure, achieve blood pressure targets, and facilitate use of antihypertensives than usual care, and pharmacist-led interventions appear more effective than nurse-led interventions. Permitting nurses and pharmacists to alter or prescribe antihypertensive medications improves the impact of interventions.
- Christopher Clark, East Somerset Resarch Consortium, West Coker, Somerset, UK
- Lindsay Smith, Department of General Practice, National University of Ireland, Galway, Ireland
- Liam Glynn, Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- Lyne Cloutier, School of Nursing, University of Southampton, Southampton, Hants, UK
- Olivia Clark
- Rod Taylor, East Somerset Resarch Consortium, West Coker, Somerset, UK
- John Campbell, East Somerset Resarch Consortium, West Coker, Somerset, UK