Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, St Luke's Campus, Exeter EX1 2LU.
BMJ. 2010 Aug 23;341:c3995. doi: 10.1136/bmj.c3995.
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.
Systematic review and meta-analysis.
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.
Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults.
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.
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).
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.
综述初级保健中护士主导的高血压干预措施试验，以明确证据基础，确定护士处方是否为重要干预措施，并确定需要进一步研究的领域。
系统评价和荟萃分析。
Ovid Medline、Cochrane 对照试验中心注册库、英国护理索引、Cinahl、Embase、效应摘要数据库、NHS 经济评价数据库。
与常规护理相比，针对成年人高血压的护理干预的随机对照试验。
收缩压和舒张压、达到目标血压的百分比以及服用抗高血压药物的百分比。干预效果以相对风险或加权均数差计算，视情况而定，并对研究质量进行敏感性分析。
与常规护理相比，包含阶梯式治疗方案的干预措施显示收缩压降低更显著（加权均数差 -8.2mmHg，95%置信区间 -11.5 至 -4.9），护士处方显示血压降低更显著（收缩压 -8.9mmHg，-12.5 至 -5.3 和舒张压 -4.0mmHg，-5.3 至 -2.7），电话监测显示血压目标达标率更高（相对风险 1.24，95%置信区间 1.08 至 1.43），社区监测显示血压降低更显著（加权均数差，收缩压 -4.8mmHg，95%置信区间 -7.0 至 -2.7 和舒张压 -3.5mmHg，-4.5 至 -2.5）。
高血压的护士主导干预措施需要一种算法来构建护理。来自非英国医疗保健环境的护士处方者的证据表明治疗结果有所改善。来自英国初级卫生保健的高质量证据不足以支持在这种医疗保健系统中广泛雇用护士来管理高血压。
