Effectiveness of nurse-led hypertension self-management interventions: A mixed-methods systematic review and meta-analysis.
Sylvia P Adzitey, Furaha Akimanimpaye, Talitha Crowley
PMID 41937999WHAT IT FOUND
Nurse-led hypertension self-management lowered systolic and diastolic blood pressure versus usual care.
The reductions were still seen at later follow-up. It also improved knowledge and some health behaviours.
Key findings
01Across 18 randomized trials, nurse-led self-management interventions were associated with a pooled systolic blood pressure estimate 7.60 mmHg lower and a pooled diastolic blood pressure estimate 4.12 mmHg lower than usual care.
02At follow-up of six months or longer, the pooled systolic estimate was 7.25 mmHg lower and the pooled diastolic estimate was 3.29 mmHg lower.
03The qualitative evidence was limited to one mixed-methods study; its themes included knowledge, adherence, support networks, and barriers such as low health literacy.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The interventions varied in setting, duration, delivery mode and self-management content, so the pooled estimate does not identify which components worked. The between-study variability was very high for both primary outcomes. Only one included study had a qualitative component, so evidence about patient and nurse experience is limited. Most studies were from Asia, while the review aimed to inform an African guideline, so cultural and system fit may differ. Participants had primary hypertension and comorbidities were excluded, so results may not apply to patients with diabetes or other conditions. Blinding was limited: participants were blinded in only 11.1% of randomized trials, and treatment providers were not blinded. The paper states 2,706 participants and 342 withdrawn, but does not give the analysed number or how withdrawals were handled. Secondary outcomes were not pooled because measurement methods differed, so their certainty is lower. Only English-language studies were included, which may omit relevant evidence.
Declared interests
The authors declare no competing interests. The supplied text does not report funding or sponsor involvement.
The easy way to misread this
Do not treat the pooled systolic reduction of 7.60 mmHg as a guaranteed reduction for every patient. The studies varied widely, and excluding one outlier changed the pooled estimate to 6.68 mmHg.