Nurse Led Interventions in Hypertension

Abstract

Hypertension is predominantly detected and managed in primary or community care settings. Nurses are key members of the multidisciplinary primary care team and are commonly involved in measuring or managing blood pressure. Nurses undertake a range of tasks in hypertension care and many randomised controlled trials of different nurse led interventions have been conducted, providing evidence from different populations. There is good evidence to support better blood pressure outcomes when nurses deliver care face to face, but not remotely. Other important components of these complex interventions appear to be the inclusion of a structured care algorithm, ability to prescribe or alter medications, and maintaining contact at least monthly until blood pressure is controlled to target. There is limited reporting of the costs of interventions and evidence for cost-effectiveness of nurse led care compared to usual care is lacking. There is no clear evidence from longer term follow-up of the effect of nurse led interventions on cardiovascular outcomes. The design of programmes for nurse led care in hypertension should take account of the existing evidence and areas of uncertainty. Nurses generally work within teams and future studies of team approaches to hypertension, either including or led by nurses, are needed. Any future studies of nurse led care should include a robust cost-effectiveness analysis.