title: Nurse-led interventions used to improve control of high blood pressure in people with diabetes: a systematic review and meta-analysis.
abstract: BACKGROUND
  Previous reviews demonstrate uncertainty about the effectiveness of nurse-led interventions in the management of hypertension. No specific reviews in diabetes have been identified. We have systematically reviewed the evidence for effectiveness of nurse-led interventions for people with diabetes mellitus.
  
  
  METHODS
  In this systematic review and meta-analysis, searches of Medline, Embase, CINAHL and the Cochrane Central Trials register were undertaken to identify studies comparing any intervention conducted by nurses in managing hypertension in diabetes with usual doctor-led care. Additional citations were identified from papers retrieved and correspondence with authors. Outcome measures were absolute systolic and diastolic blood pressure, change in blood pressure, proportions achieving study target blood pressure and proportions prescribed anti-hypertensive medication.
  
  
  RESULTS
  Eleven studies were identified. Interventions included adoption of treatment algorithms, nurse-led clinics and nurse prescribing. Meta-analysis showed greater reductions in blood pressure in favour of any nurse-led interventions (systolic weighted mean difference -5.8 mmHg, 95% CI -9.6 to -2.0; diastolic weighted mean difference -4.2 mmHg, 95% CI -7.6 to -0.7) compared with usual doctor-led care. No overall superiority in achievement of study targets or in the use of medication was evident for any nurse-based interventions over doctor-led care.
  
  
  CONCLUSIONS
  There is some evidence for improved blood pressure outcomes with nurse-led interventions for hypertension in people with diabetes compared with doctor-led care. Nurse-based interventions require an algorithm to structure care and there is some preliminary evidence for better outcomes with nurse prescribing. Further work is needed to elucidate which nurse-led interventions are most effective.
authors.affiliation: Institute of Health Services Research, Peninsula College of Medicine and Dentistry, Exeter, UK. christopher.clark@pms.ac.uk
authors.forename: C E
authors.initials: CE
authors.lastname: Clark
authors.forename: L F P
authors.initials: LF
authors.lastname: Smith
authors.forename: R S
authors.initials: RS
authors.lastname: Taylor
authors.forename: J L
authors.initials: JL
authors.lastname: Campbell
mesh_terms: D000465:Algorithms; D001794:Blood Pressure / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000451:nursing* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000451:nursing* / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*