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Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

BMJ 2010; 341 doi: (Published 23 August 2010) Cite this as: BMJ 2010;341:c3995
  1. Christopher E Clark, clinical academic fellow,
  2. Lindsay F P Smith, senior clinical research fellow,
  3. Rod S Taylor, professor in health services research,
  4. John L Campbell, professor of general practice and primary care
  1. 1Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, St Luke’s Campus, Exeter EX1 2LU
  1. Correspondence to: C E Clark christopher.clark{at}
  • Accepted 11 June 2010


Objective 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.

Design Systematic review and meta-analysis.

Data sources 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.

Study selection Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults.

Data extraction 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.

Data synthesis 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).

Conclusions 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.


  • We thank Kate Quinlan (East Somerset Research Consortium) for carrying out the searches and retrieving articles, Joy Choules (Primary Care Research Group) for helping retrieve articles, and Liam Glynn (Cochrane Hypertension Group) for sharing citation lists.

  • Contributors: CEC and LFP reviewed the literature search results, identified papers for retrieval, reviewed full papers for inclusion, and extracted data for meta-analysis. CEC and RST undertook the meta-analysis. JLC acted as study supervisor. All authors contributed to the interpretation of the findings and drafting of the manuscript. CEC is guarantor for the study.

  • Funding: This research was supported by the Scientific Foundation Board of the Royal College of General Practitioners and by the South West GP Trust.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any company for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Accepted 11 June 2010

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