Akasaki Yuichi, Suematsu Yasunori, Azushima Kengo, Shiga Yuhei, Sakima Atsushi, Satoh Michihiro, Arima Hisatomi, Hirawa Nobuhito
Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
Hypertens Res. 2025 Feb 17. doi: 10.1038/s41440-025-02152-9.
Hypertension is a significant risk factor for cardiovascular diseases, with its global prevalence doubling over the past three decades. Despite advancements in antihypertensive therapies, approximately 50% of patients with hypertension fail to achieve their target blood pressure (BP) levels, underscoring the need for innovative care strategies. Patient care teams comprising multidisciplinary healthcare providers have shown promise in improving BP management. This systematic review and meta-analysis were aimed at evaluating the effectiveness of patient care teams involving physicians in hypertension management. To this end, PubMed, Cochrane CENTRAL, and IchuShi-Web were comprehensively searched and 61 randomized controlled trials including 64,857 participants were identified. Compared with usual care, interventions by patient care teams significantly reduced office systolic BP (mean difference: -6.31 mmHg; 95% confidence interval: -7.71 to -4.90) and decreased the risk of uncontrolled BP by 27% (risk ratio: 0.73; 95% confidence interval: 0.68-0.79). Subgroup analyses demonstrated consistent BP reductions across various team leadership roles, such as physicians, nurses, and pharmacists, and across different intervention durations. These findings highlight the effectiveness of team-based BP management in achieving improved BP control, regardless of team composition or the follow-up period. Multidisciplinary care offers a viable approach to addressing the unmet needs of patients with hypertension, potentially improving cardiovascular outcomes. This evidence supports integrating patient care teams into hypertension management, particularly in settings requiring physician oversight. Future research should focus on refining team structures and tailoring interventions to diverse healthcare environments to enhance their impact.
高血压是心血管疾病的一个重要危险因素，在过去三十年中其全球患病率翻了一番。尽管抗高血压治疗取得了进展，但仍有大约50%的高血压患者未能达到其目标血压水平，这凸显了创新护理策略的必要性。由多学科医疗服务提供者组成的患者护理团队在改善血压管理方面已显示出前景。这项系统评价和荟萃分析旨在评估有医生参与的患者护理团队在高血压管理中的有效性。为此，全面检索了PubMed、Cochrane CENTRAL和IchuShi-Web，共识别出61项随机对照试验，涉及64,857名参与者。与常规护理相比，患者护理团队的干预措施显著降低了诊室收缩压（平均差值：-6.31 mmHg；95%置信区间：-7.71至-4.90），并将血压未得到控制的风险降低了27%（风险比：0.73；95%置信区间：0.68 - 0.79）。亚组分析表明，在不同的团队领导角色（如医生、护士和药剂师）以及不同的干预持续时间内，血压均持续降低。这些发现凸显了基于团队的血压管理在实现更好的血压控制方面的有效性，无论团队组成或随访期如何。多学科护理为满足高血压患者未得到满足的需求提供了一种可行的方法，有可能改善心血管结局。这一证据支持将患者护理团队纳入高血压管理，尤其是在需要医生监督的环境中。未来的研究应侧重于优化团队结构，并针对不同的医疗环境调整干预措施，以增强其影响。
