Table 2.
Study characteristics in the included studies
| Study | Population | Intervention | Outcomes | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Author, year of publication | Length of RCT,weeks | County, settings | Sample size No. cluster/No. participants |
Age, mean | Female, % | Hypertensive complications | Baseline mean BP SBP/DBP, mmHg | The details of carea | Achievement of BP control goals at the primary outcome (SBP/DBP mmHg) | Sphygmomanometer type | |
| Amado GE, 2011 [21] | 52 | Spain, | 18 | 481 | 63.4 | 64.2 | 139.3/82.2 | Usual care | |||
| Community health care centers | 18 | 515 | 63.3 | 67.7 | Unclear | 140.9/82.5 | Personalized information by a trained nurse, and written leaflets. The disease, healthy lifestyle habits, and messages targeted to each group of antihypertensive drugs used (mechanism of action, dosage, what to do if a pill is missed, adverse effects, and other recommendations) were contained | - | Mercury | ||
| Beune EJAJ, 2014 [22] | 26 | Netherlands, | 2 | 71 | 54.6 | 44.0 | 155.2/89.6 | Usual care | |||
| Community health care centers | 2 | 75 | 53.3 | 61.0 | Unclear | 156.7/91.0 | Nurse-led culturally appropriate HT education sessions: counselling and educational materials; if applicable, referrals to neighborhood facilities, such as walking clubs and health food stores, that support patients in adopting healthier lifestyles | - | Automated | ||
| Bogner HR, 2013 [23] | 12 | USA, | - | 30 | 65.8 | 60.0 | 139.4/76.4 | Usual care | |||
| Community-based primary care practices | - | 30 | 68.3 | 70.0 | + | 133.6/76.5 | An integrated care by licensed practical nurses: provision of an individualized program to improve adherence to antidepressants and antihypertensives, and integration of depression treatment with HT management | - | Automated | ||
| Boswort HB, 2009 [24] | 104 | USA, | - | 159 | 62.0 | 64.0 | 124/70 | Usual care | |||
| Primary care clinics | - | 160 | 60.0 | 67.0 | + | 124/71 | Nurse administered telephone-based tailored behavioral intervention: included perceived risk of HT, memory, literacy, social support, patients’ relationships with their health care providers, and side effects of anti-hypertension medication; and focused on improving adherence to the following HT recommendations: the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, weight loss, reduced sodium intake, regular moderate intensity physical activity, smoking cessation, and moderation of alcohol intake | < 140/90 mmHg, diabetes: < 130/80 mmHg | Automated | ||
| - | 159 | 61.0 | 62.0 | 126/72 | A combination of medication and behavioral management: received a home BP monitor, training on its use, and the bi-monthly nurse-administered behavioral self-management intervention | ||||||
| - | [158] | [62.0] | [71.0] | [126/72] | [Home BP monitoring] | ||||||
| Boswort HB, 2011 [25] | 78 | USA, | - | 147 | 64.0 | 4.0 | 128/78 | Usual care | |||
| Home-based and community-based care settings | - | 148 | 63.0 | 8.0 | + | 129/77 | Nurse-administered, behavioral management intervention: used an intervention software application. cf. BosworthHB2009 | < 140/90 mmHg, | Automated | ||
| - | 149 | 64.0 | 7.0 | 132/78 | Nurse-administered, physician-directed medication management intervention using a validated clinical decision support system | diabetes: < 130/80 mmHg | |||||
| - | 147 | 63.0 | 14.0 | 127/77 | Combined behavioral management and medication management intervention | ||||||
| Cakmak V, 2021 [26] | 13 | Turkey, | - | 50 | 55.1 | 64.0 | 130.0/82.4 | Usual care | |||
| Community health care centers | - | 50 | 55.4 | 68.0 | - | 127.7/83.3 | One-on-one training in the form of one-on-one verbal expression and question–answers. Colorful education booklets were given to the patients for reading at home | - | Unclear | ||
| Dejesus RS, 2009 [27] | 26 | USA, | - | 18 | 148.4/73.5 | Usual care | |||||
| Primary care clinics | - | 17 | < = 60y 13people, | 52.0 | + | 152.41/73.4 | A class focusing on HT in diabetes and BP checked by a registered nurse | - | Automated | ||
| - | 19 | > 60y 41people | 148.3/72.0 | A class focusing on HT in diabetes, BP checked by a registered nurse and received additional instruction on home BP monitoring from registered nurse | |||||||
| Duong D, 2004 [28] | 104 | USA, | - | 57 | 61.9 | 36.8 | 136.4/78.7 | Usual care | |||
| Military medical centers | - | 90 | 57.0 | 45.6 | Unclear | 133.0/74.8 | A comprehensive educational-behavioral intervention program: knowledge regarding HT, adherence to recommended therapies, communication skills with health care providers, lifestyle behaviors, blood pressure control, and satisfaction with care by clinical nurse specialist; Based on the PRECEDE-PROCEED model, the goals of lower high blood pressure and improve patient satisfaction with available health care | < 140/90 mmHg | Mercury | ||
| Feldman PH, 2020 [29] | 52 | USA, | - | 165 | 66.5 | 58.8 | 154.3/86.2 | Usual home care (UHC) | |||
| Home-based and community-based care settings | - | 165 | 66.9 | 59.4 | + | 154.9/85.7 |
UHC, and a 30-day nurse practitioner (NP) transitional care program The NP was responsible for (1) conducting a comprehensive health assessment; (2) communicating with the patient's physicians and UHC nurse; (3) monitoring BP; (4) ensuring appropriate medication and behavioral regimens; (5) collaborating with patients and caregivers to overcome barriers and adhere to a tailored, culturally sensitive self-management plan; and (6) addressing patients' social support needs through referral to appropriate community resources |
- | Automated | ||
| - | 165 | 66.4 | 52.7 | 154.2/85.5 | UHC, and the intensive 30-day NP intervention plus a 60-day of coaching/self-management support from a home health aide specially trained to be a heath coach | ||||||
| Feldman PH, 2016 [30] | 52 | USA, | - | 292 | 63.3 | 66.0 | 154.5/87.6 | Usual home care | |||
| Home-based and community-based care settings | - | 267 | 65.1 | 65.0 | + | 155.7/86.5 | Usual home care, and field nurses received the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) guide, BP monitor with instructions | < 140/90 mmHg | Automated | ||
| - | 286 | 64.4 | 70.0 | 154.1/87.0 | Augmented Usual home care: incorporated all components of the basic intervention and of usual home care. For stage 2 HT, usual home care plus provided HT medication assessment, monitoring, education and self-management support by nurse and a health educator | < 130/80 mmHg for patients with diabetes or kidney disease: JNC7 guidelines | |||||
| Given CW, 1984 [31] | 39 | USA, | - | 24 | 45.9 | 142.8/93.8 | Usual care | ||||
| Mixed settings (family-practice and office practice) | - | 62 | 47.7 | Unclear | Unclear | 145.0/93.5 | The problem-solving intervention upon patients’ beliefs about and control of BP by nurses. Educational handbook was used describing the risks of HT | - | Unclear | ||
| Kabayama M, 2021 [32] | 26 | Japan, | - | 25 | 64.6 | 0 | 141.6/82.1 | Usual care | |||
| Primary care clinics | - | 28 | 63.4 | 0 | + | 140.4/84.2 | Health guidance provided face-to face, aiming at optimal alcohol habits by trained nurses | - | Automated | ||
| Kastarinen MJ, 2002 [33] | 104 | Finland, | - | 355 | 54.2 | 54.0 | 148/91 | Usual care | |||
| Community health care centers | - | 360 | 54.4 | 52.0 | + | 149/91 | Systematic health counselling given by local public health nurses. This intervention goals for the study subjects were: (1) normal weight (BMI, 25 kg/m2); (2) daily sodium chloride intake less than 5 g; (3) alcohol consumption fewer than two drinks per day; (4) to exercise at moderate intensity at least three times per week for 30 min; and (5) to stop smoking if a smoker | - | Mercury | ||
| Kes D, 2021 [34] | Turkey, | - | 46 | 52.2 | 55.3 | 155.3/94.2 | Usual care | ||||
| 12 | Community health care centers | - | 46 | 54.9 | 51.3 | Unclear | 156.3/95.1 | Nurse-led support by regular text messages and phone calls to take prescribed medication | < 140/90 mmHg | Automated | |
| Kolcu M, 2020 [35] | 24 | Turkey, | - | 38 | 75.6 | 43.2 | 119.2/75.1 | Usual care | |||
| Nursing homes | - | 38 | 75.6 | 48.6 | Unclear | 129.2/79.7 | Nurse-led HT management program included the Dietary Approach to Stop Hypertension (DASH) diet, and dietary approach; The training program (Health education and motivational meetings) consisted of individual and group interventions together with actions taken at the institutional level | - | Mercury | ||
| Leiva A, 2014 [36] | 52 | Spain, | - | 115 | 66.7 | 46.1 | 155.5/83.6 | Usual care | |||
| Community health care centers (primary care centers) | - | 115 | 64.5 | 41.0 | + | 156.3/84.7 | A multifactorial adherence-based intervention including nurse-led motivational interviews based on the Heath Belief Model, pillbox reminders, family support, BP self-recording, and simplification of the dosing regimen by a pharmacist | - | Automated | ||
| Litaker D, 2003 [37] | 104 | USA, | - | 78 | 60.6 | 58.0 | Usual care | ||||
| Hospital (Department of General Internal Medicine) | - | 79 | 60.5 | 59.0 | + | Unclear | The intervention focused on chronic disease management by physician-nurse practitioner teams, and the use of clinical practice algorithms, patient education on disease self-management strategies, and regular monitoring and feedback delivered primarily by the nurse practitioner | < 130/85 mmHg | Unclear | ||
| Logan AG, 1983 [38] | 52 | Canada, | - | 97 | 49.3 | 30.9 | 154.9/103.3 | Usual care | |||
| Companies | - | 97 | 50.8 | 23.7 | Unclear | 154.3/103.7 | The treatment by their family doctor and the occupational health nurse (OHN) at their place of employment; The process of care of HT patients by the OHN (i.e., referral to a physician, initiation of appropriate therapy, and long-term maintenance of treatment). The OHN was instructed to ensure that employees saw their family physician and to assist employees without a physician to obtain one |
Baseline DBP > = 95 mmHg: < DBP 90 mmHg, DBP 91-94 mmHg: -6 mmHg |
Mercury | ||
| Ma C, 2014 [39] | 24 | China, | - | 60 | 58.4 | 53.3 | 150.3/88.7 | Usual care | |||
| Community health care centers | - | 60 | 59.2 | 48.3 | Unclear | 153.2/89.0 | Counselling based on motivational interviewing and social cognitive theory, and designed to address HT care. The nurses asked the patients to record a daily diary, and the content included information on adherence to medication, dietary habits, physical activity, drinking and smoking, illness perception, physical health, and mental health | - | Automated | ||
| Ma Y, 2022 [40] | 12 | China, | - | 105 | 61.5 | 54.3 | 150.6/93.3 | Usual care | |||
| Community health care centers | - | 105 | 59.6 | 51.4 | + | 149.7/93.8 | Six individual weekly education and consultation sessions provided by a nurse in the first 6 weeks and a smartphone application for 12 weeks. The sessions consisted of health education, individual self-care planning, daily records of physical health status and lifestyle behavior, and an automated weekly health report | < 140/90 mmHg | Automated | ||
| Matteida Silva ÂT, 2020 [41] | 52 | Brazil, | - | 47 | 49.2 | 72.3 | 134.7/85.1 | Usual care | |||
| Primary care clinics | - | 47 | 49.4 | 83.0 | + | 135.2/85.6 |
Nursing case management model included:(1) nursing consultations; (2) telephone contact to re‐evaluate the patients’ healthcare plans, remind them of their consultation agendas, provide guidance for the adoption of healthy habits and disease control with WhatsApp®; (3) home visits; (4) health education; and (5) appropriate referrals Group activities were focused on topics such as the development of healthy habits, physical activity, treatment adherence, blood pressure measurement, and chronic complications |
< 140/90 mmHg | Automated | ||
| Miao J-H, 2020 [42] | 16 | China, | - | 78 | 66.8 | 53.9 | Usual care | ||||
| Community health care centers | - | 78 | 68.9 | 49.0 | + | Unclear | The nurse-led HT management involved home visits guided by the Omaha System, telephone follow-ups and referrals; included smoking cessation, alcohol restriction, salt restriction, regular physical activity, and home BP monitoring. The trained nurses performed relevant interventions that included teaching/guidance/ counseling in lifestyle modification changes, treatment and procedures such as timing and dosage adjustment as well as drug interactions and physical activity, and case management | - | Unclear | ||
| Okuda N, 2010 [43] | 22 | Japan, | - | 18 | 46.4 | 0 | 136.8/88.4 | Usual care | |||
| Companies | - | 18 | 45.1 | 0 | Unclear | 135.2/90.0 | Lifestyle counseling program by the occupational health nurse included salt restriction, potassium-intake addiction, physical activity, alcohol restriction, and weight loss | - | Unclear | ||
| Persell SD, 2018 [44] | 52 | USA, | 4 | 305 | 53.0 | 72.0 | 141.5/86.9 | Usual care | |||
| Community health care centers | 4 | 313 | 51.6 | 67.3 | + | 145.5/89.5 | Nurse-led medication management education and support. Nurses assessed patients’ knowledge of their chronic conditions, addressed misconceptions, and reinforced the role medications play in disease control; used the electronic health records (EHR) tools to identify potential medication errors (e.g., duplicates, internal discrepancies) and identify areas for monitoring and follow-up | < 140/90 mmHg | Automated | ||
| [4] | [302] | [53.6] | [66.8] | [148.6/89.1] | [EHR-based medication management tools alone] | ||||||
| Rudd P, 2004 [45] | 20 | USA, | - | 76 | 56.0 | 9.0 | Usual care | ||||
| Primary care clinics | - | 74 | 50.0 | 10.0 | + | Unclear | Usual care supplemented by nurse management for HT. The nurse care manager conducted baseline counseling on intervention patients’ correct use of the automated BP device, regular return of the automatically printed BP reports, tips for enhancing drug adherence, and recognition of potential drug side effects | - | Mercury | ||
| Ruppa TM, 2010 [46] | 20 | USA, | - | 5 | Unclear | 60.0 | 151.2/82.4 | Usual care | |||
| Mixed settings (home and senior living facilities) | - | 10 | Unclear | 80.0 | Unclear | 136.0/74.4 | The nurse-delivered adherence intervention consisted of 5 components: medication adherence and BP feedback, habit counseling, medication-taking skills and disease education by gerontological advanced practice nurse | - | Aneroid | ||
| Schroeder K, 2005 [47] | 26 | UK, | - | 117 | 68.2 | 46.0 | 152.1/83.1 | Usual care | |||
| Primary care clinics | - | 128 | 67.9 | 44.0 | + | 149.0/83.7 | Nurse-led adherence support (adherence-related training) to provide an opportunity for patients to talk about any problems with their blood pressure lowering medication | - | Unclear | ||
| Sen M, 2013 [48] | 52 | Sweden, | - | 50 | 62.0 | 46.0 | 165.0/92.6 | Usual care | |||
| Community health care centers | - | 59 | 65.0 | 51.0 | + | 169.0/93.1 |
BP card summarized the essential targets of HT treatment, with an added semi-structured nurse counseling The nurse-led intervention was aimed at creating an individual plan with the intention of reaching target BP as well as focusing on evidence-based guidelines on lifestyle changes and supporting the modifications the patient wanted to work with |
< 140/90 mmHg, Diabetes and kidney disease: < 130/80 mmHg, Patients who did not tolerate lower levels: < 150/90 mmHg |
Automated | ||
| - | [57] | [66.0] | [56.0] | [165.0/88.9] | [BP card only was introduced to the patient.] | ||||||
| Swain MA, 1981 [49] | 78 | USA, | - | 38 | -/101.6 | Usual care (Routine clinic care) | |||||
| Mixed settings (a clinic located in a medical center hospital and the other in a Veterans Administration hospital.) | - | 40 | Unclear | Unclear | Unclear | -/100.1 | Patient education: the instructional booklets (What you and your family need to know, Medication, Stress, Diet, and Activity) | - | Unclear | ||
| - | 37 | -/97.1 | Contingency contracting: received the instructional booklets and tests of knowledge, and wrote contracts with a nurse for targeted health goals and attendant rewards | ||||||||
| Ulm K, 2010 [50] | 52 | Germany, | - | 98 | 65.1 | 52.0 | 156.3/92.7 | Usual care | |||
| Primary care clinics (physician’s office) | - | 102 | 65.8 | 41.2 | + | 155.9/90.8 | The nurse-managed medical care programme with standardized BP measurement, self-measurement training, risk factor checks and advice on BP reduction by nurses trained intensively. Patients received a booklet on HT to receive individualized advice on how to change lifestyle factors and comply with the prescribed medication | - | Unclear | ||
| Wakefield BJ, 2011 [51] | 52 | USA, | - | 107 | 67.9 | 4.0 | 133.8/- | Usual care | |||
| Home-based and community-based care settings | - | 102 | 68.4 | 1.0 | + | 135.8/- | Low-Nurse managed home telehealth intervention directed by their physician. Patients were instructed to measure BP and blood glucose (BG) daily, and were asked “Have you taken all your medications as prescribed?” | - | Automated | ||
| - | 93 | 67.8 | 1.0 | 137.9/- |
High-Nurse managed home telehealth intervention by the study team (nurses, a physician, and a certified diabetes educator) A branching disease management algorithm by the study team was programmed into the device and focused on diet, exercise, smoking cessation, foot care, advice for sick days, medications, weight management, preventive care, and behavior modification and lifestyle adjustments. Patients were instructed to measure BP and BG daily, and received both standard prompts each day and a rotation of questions and educational content |
||||||
| Woollard J, 1995 [52] | 18 | Australia, | - | 48 | 59.0 | 50.0 | 142/80 | Usual care | |||
| General practices | - | 52 | 58.0 | 44.2 | Unclear | 145/80 | A lifestyle modification programme implemented by nurse: a low label of counselling; a single face-to-face appointment and then five telephone counselling sessions. The programme objectives were the same as the high level of counselling | - | Automated | ||
| - | 46 | 58.0 | 45.7 | 139/78 |
A lifestyle modification programme implemented by nurse: a high label of counselling; six face-to-face counselling sessions. The programme objectives were the same as the ow level of counselling The programme objectives encompassed the following: (1) Weight reduction following the Australian Nutrition Foundation guidelines (National Health and Medical Research Council (1991)); (2) In drinkers a reduction in alcohol intake to 1 standard drink a day (10 g) for women and 2 standard drinks daily (20 g) for men; (3) Salt restriction to less than 90 mmol/day; (4) Less than 30% daily energy dietary fat with restriction of saturated fat intake to 10%; (5) An increase in regular leisure time physical activity; and (6) Smoking cessation |
||||||
| Zabler B, 2018 [53] | 26 | USA, | - | 30 | 53.6 | 70.0 | 130.5/78.2 | Usual care | |||
| Primary care clinics | - | 29 | 53.9 | 55.2 | Unclear | 131.6/80.0 | Ecological nurse case management intervention on perceived stress, self-efficacy, and self-management behaviors. The intervention is individualized to each patient and a key of ‘Mutual Self-Management Goal Setting’. The primary nurse actions included: self-management support, inclusive of both health education and behavior modification; technical procedures; care coordination; and/or surveillance | - | Unclear | ||
| Zang XY, 2010 [54] | 13 | China, | - | 36 | Unclear | Unclear | 158.6/88.3 | Usual care | |||
| Hospital (the medical clinic of the General Hospital) | - | 36 | Unclear | Unclear | Unclear | 152.5/87.5 |
Behaviour interventions included the following; instructing patients to obey the types and doses of medicine and adjust the time of taking medicine according to chrono-therapeutics (the purposeful alteration of drug levels to match rhythms to optimise therapeutic outcomes and minimise size effects); and advising them to change bad lifestyles such as reducing physical activities when BP was rising, giving the plan for an anti-hypertensive diet and quitting cigarettes and alcohol, etc The psychological interventions (helping participants accommodate their mode to avoid the fluctuation of BP) under ambulatory BP monitoring |
- | Automated | ||
| Zhu X, 2018 [55] | 16 | China, | - | 67 | 69.0 | 52.2 | 149.7/83.5 | Usual care | |||
| Community health care centers | - | 67 | 69.0 | 49.3 | + | 153.9/82.6 | Nurse-led HT management model including four components (delivery system design, decision support, clinical information system and self-management support) was developed. The trained nurses performed relevant interventions that included teaching/guidance/counseling, treatment and procedures, and case management. The self-management, such as salt intake control, regular engagement in physical activities, home BP monitoring management, and medicine storage, were included | - | Unclear | ||
BP blood pressure, DBP diastolic blood pressure, SBP systolic blood pressure, HT hypertension
+ : Applicable, - : No report
a[ ]: excluded from the meta-analysis not to be nurse-led intervention