Vay-Demouy Juliette, Lelong Hélène, Blacher Jacques
Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France.
BMC Nurs. 2025 Jul 1;24(1):763. doi: 10.1186/s12912-025-03328-x.
Since the 1960s, advanced practice nurses have gradually emerged worldwide. They are playing an increasingly role in hypertension management, due to their field of expertise at the interface of nursing and medicine. However, there seems to be little evidence to date of their impact on blood pressure control in hypertension management, even though this is a major chronic pathology, with significant cardiovascular morbidity and mortality. Given the lack of trials assessing advanced practice nurse-led interventions in hypertension management, this systematic review and meta-analysis aimed to evaluate the effectiveness of nurse-led interventions with prescriptive authority in improving BP control compared to usual physician-led care.
A systematic review and meta-analysis of randomized controlled trials (RCTs) focused on our topic were conducted. A random-effects model was used to estimate pooled mean differences for BP reduction and odds ratios (OR) for BP control. Sensitivity analyses and publication bias assessments were performed.
A meta-analysis of five RCTs showed a significant reduction in systolic BP (-17.73 mmHg, 95% CI: -29.19 to -6.27, p = 0.0024, I² = 99.1%). After excluding two highly influential studies, the effect remained significant (-16.54 mmHg, 95% CI: -23.26 to -9.83, p < 0.001) with reduced heterogeneity (I² = 78.4%). For diastolic BP, a meta-analysis of four RCTs reported a reduction of -9.96 mmHg (95% CI: -18.56 to -1.36, p = 0.0232, I² = 95.6%), which remained significant after sensitivity analysis (-13.25 mmHg, 95% CI: -21.63 to -4.87, p = 0.0019, I² = 89.4%). No robust conclusion could be drawn for BP control (OR) due to the limited number of studies.
Nurse-led interventions with prescriptive authority significantly reduced blood pressure levels versus usual physician-led care. These findings support the implementation of advanced practice nurses (or similar) in hypertension management, but more research is needed to improve the evidence given the significant lack of data in the literature.
Not applicable.
自20世纪60年代以来，高级执业护士在全球范围内逐渐兴起。由于他们在护理与医学交叉领域的专业知识，他们在高血压管理中发挥着越来越重要的作用。然而，尽管高血压是一种主要的慢性疾病，具有显著的心血管发病率和死亡率，但迄今为止，几乎没有证据表明他们在高血压管理中对血压控制有何影响。鉴于缺乏评估由高级执业护士主导的高血压管理干预措施的试验，本系统评价和荟萃分析旨在评估与普通医生主导的护理相比，具有处方权的护士主导干预措施在改善血压控制方面的有效性。
对聚焦于我们主题的随机对照试验（RCT）进行了系统评价和荟萃分析。采用随机效应模型来估计血压降低的合并平均差异和血压控制的比值比（OR）。进行了敏感性分析和发表偏倚评估。
对五项RCT的荟萃分析显示收缩压显著降低（-17.73 mmHg，95%可信区间：-29.19至-6.27，p = 0.0024，I² = 99.1%）。排除两项极具影响力的研究后，效果仍然显著（-16.54 mmHg，95%可信区间：-23.26至-9.83，p < 0.001），异质性降低（I² = 78.4%）。对于舒张压，对四项RCT的荟萃分析报告降低了-9.96 mmHg（95%可信区间：-18.56至-1.36，p = 0.0232，I² = 95.6%），敏感性分析后仍然显著（-13.25 mmHg，95%可信区间：-21.63至-4.87，p = 0.0019，I² = 89.4%）。由于研究数量有限，无法就血压控制（OR）得出有力结论。
与普通医生主导的护理相比，具有处方权的护士主导干预措施显著降低了血压水平。这些发现支持在高血压管理中实施高级执业护士（或类似人员），但鉴于文献中数据严重不足，需要更多研究来完善证据。
不适用。
