Practice nurse management of hypertension in primary care: a scoping review.

Abstract

Aim: To review the current diagnosis and treatment of hypertension (HTN) and explore alternative care management options.

Background: HTN is underdiagnosed and poorly managed in the UK. With an increasing emphasis on teamwork in primary care (PC), what is the evidence base supporting the partial or complete management of HTN by practice nurses (PNs)?

Methods: Using the PRISMA-Scr checklist as a framework, six database searches (BNI, CINAHL, Embase, Emcare, Medline, and PubMed) were conducted using Boolean Operators between December 2023 and February 2024, employing four search structures to find literature on independent or collaborative HTN management by PNs. Qualitative and quantitative research studies, reports, and articles were all considered.

Findings: HTN is a significant risk factor for mortality and morbidity. Despite clear national guidelines on the diagnosis and management, many patients affected by this condition remain undiagnosed, with the majority of those diagnosed inadequately treated. PC is struggling to manage the workload due to an ageing population and reduced general practitioner (GP) numbers. The development of new roles to support GPs in their work is underway, but current roles remain vague and without nationally agreed remits or working practices. PNs currently manage most chronic non-communicable diseases, such as diabetes, asthma, and chronic obstructive pulmonary disease; however, HTN is not typically part of their remit. There is strong quantitative and qualitative evidence supporting PNs' involvement in HTN management as care coordinators. Such a move could improve patient outcomes and release GP time, but institutional barriers need to be addressed.