Effectiveness of nursing case management versus usual care for blood pressure control in adults with hypertension: a systematic review.
Maria de Fátima Mantovanil, Luciana Puchalski Kalinke, Ângela Taís Mattei da Silva and 3 others
PMID 33687808WHAT IT FOUND
Some nurse-led case management trials lowered blood pressure at six months, but the review did not find consistent control at 12 months.
Use structured follow-up as an add-on to usual care, not as a proven way to lower blood pressure.
Key findings
01Nursing case management lowered systolic blood pressure significantly in two trials and diastolic blood pressure significantly in three trials, all favoring the intervention group, and these significant results came from six-month follow-up.
02The review could not statistically combine the trials because the case-management activities and outcome measurements varied widely, and it concluded effectiveness was not consistently detected.
03The certainty was very low for six-month systolic blood pressure, low for six-month diastolic blood pressure, low for 12-month systolic blood pressure, and moderate for 12-month diastolic blood pressure.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Participants and treatment providers were not blinded, and outcome assessor blinding or allocation methods were unclear in some trials. The certainty was downgraded because of risk of bias, high inconsistency, and imprecision from small samples. The case-management activities varied widely across trials, so no single component can be credited. Outcome measurement differed across trials, and a 12-month trial did not report final mean blood pressure values or a significance test. The review could not perform meta-analysis because of heterogeneity, and some eligible studies may have been missed. Included studies were European primary care trials, including a specific population of Ghanaians and Surinamese, so generalizability may be limited.
The easy way to misread this
Do not conclude that nurse case management reliably controls blood pressure. The review found significant reductions only in some six-month trials, the certainty was low or very low for systolic blood pressure, and the effect cannot be separated from the many bundled activities such as visits, calls, reminders, education, and medication reviews.