Evidence Summary

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Nurse-led care may reduce diastolic and systolic blood pressure in people living with high blood pressure

Bulto LN, Roseleur J, Noonan S, et al. Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: A systematic review and meta-analysis Eur J Cardiovasc Nurs. 2023;0: zvad040.

Review question

What are the effects of nurse-led care on hypertension management, lifestyle behaviour, and patients’ knowledge in people living with high blood pressure compared to usual care?


Globally, more than 1.3 billion people live with high blood pressure (aka hypertension), increasing their risk of cardiovascular disease.  A comprehensive approach for managing high blood pressure includes medication, lifestyle management, education, and counselling. Nurses may be well positioned to deliver this holistic strategy, but previous research has yielded inconsistent results and demonstrated gaps that need to be addressed.

How the review was done

This is a systematic review of 37 randomized control trials, 31 of which were included in a meta-analysis. The studies were published between 2001 and 2021 and included a total of 9,731 participants.

Key features of the included studies:

  • The average age of the participants, all of whom had high blood pressure, ranged from 41 to 75 years.
  • Participants received nurse-eld care, which was often delivered face-to-face and included education and counselling on high blood pressure.
  • Researchers measured changes in blood pressure, health behaviour, and knowledge.
  • Results were compared with people in control groups who received usual hypertension care (e.g., clinic-based care management, home blood pressure monitoring, or doctor-led care).

What the researchers found

Nurse-led care may help reduce diastolic and systolic blood pressure for up to six months compared to usual care. These benefits do not appear to be maintained at 12 months. Limited evidence shows that physical activity levels and some aspects of diet may also improve with nurse-led care. However, impacts on smoking, alcohol intake, and knowledge of the disease or risk factors are not clear. The results are based on low to moderate certainty evidence and may change as more evidence emerges. Further high-quality research is needed, especially in areas with limited evidence.


Nurse-led care may play a beneficial role in hypertension management by reducing blood pressure and improving certain lifestyle behaviours like physical activity and aspects of diet compared to usual care.  


Control group
A group that receives either no treatment or a standard treatment.
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Advanced statistical methods contrasting and combining results from different studies.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Blood pressure screening

    Health Link B.C.
    Hypertension Canada recommends that all adults get their blood pressure tested when they visit the doctor. How often your blood pressure needs to be checked will be determined by your doctor based on your blood pressure and risk for heart disease.
  • Patient education: High blood pressure in adults (Beyond the Basics)

    UpToDate - patient information
    Blood is transported from the heart to other organs and areas of the body by the arteries. Blood pressure is the pressure that is exerted on the inner walls of these arteries by blood. Generally, to be diagnosed with high blood pressure, you must exhibit continuously high blood pressure at two different doctor's visits spaced at least 7 days apart.
  • High blood pressure

    Informed Health Online
    High blood pressure can lead to a variety of medical issues if left untreated. It is often symptomless until it becomes extremely high, at which point people can experience vision problems and dizziness. High amounts of salt and alcohol intake, excess weight, lack of physical activity, family history, certain medications, and an overactive thyroid are some causes and risk factors for high blood pressure. Strategies such as consuming less salt, exercising more, losing weight, and medication prescribed by a health care provider can be used to help lower blood pressure.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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