Impact of nurse-led interventions with prescriptive authority on blood pressure control in hypertension management: a systematic review and meta-analysis.

BACKGROUND

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.

METHOD

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.

RESULTS

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.

CONCLUSION

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.

CLINICAL TRIAL NUMBER

Not applicable.