This scoping review set out to summarise the current state of hypertension (HTN) diagnosis and treatment in primary care and to explore alternative care-management models that involve practice nurses (PNs). The authors contextualised the review within the UK, noting that HTN remains a major risk factor for mortality and morbidity and that, despite established national guidelines, many patients remain undiagnosed or inadequately treated.
The review sought to clarify whether partial or complete management of HTN by PNs is supported by the evidence, given increasing emphasis on multidisciplinary teamwork in primary care and evolving roles intended to support general practitioners (GPs).
The review used the PRISMA-ScR checklist as its framework. Six bibliographic databases (BNI, CINAHL, Embase, Emcare, Medline, and PubMed) were searched between December 2023 and February 2024. The authors applied four search structures with Boolean operators to identify literature on independent or collaborative HTN management by PNs. The review included both qualitative and quantitative research, reports, and articles.
Details such as the number of records retrieved, study selection criteria beyond study design types, and methods for data extraction or synthesis are not reported in the abstract.
The review reiterates that HTN is a significant contributor to morbidity and mortality. It highlights two persistent problems in the UK primary care context: underdiagnosis of HTN and suboptimal treatment among those who are diagnosed. These gaps persist despite clear national guidance available for HTN diagnosis and management.
Primary care services are described as struggling to meet demand because of an ageing patient population and reductions in GP numbers. In response, development of new roles to support GPs is underway. However, according to the review, these emerging roles often remain vaguely defined and are not supported by nationally agreed remits or standardised working practices.
This workforce context frames the rationale for examining whether practice nurses could take on more responsibility for HTN management to relieve GP workload.
Practice nurses already undertake management for many chronic non-communicable diseases in primary care — the abstract specifically mentions diabetes, asthma, and chronic obstructive pulmonary disease (COPD) as conditions commonly within PN remit. By contrast, HTN is noted as not typically included in routine practice nurse responsibilities.
The review reports that there is strong quantitative and qualitative evidence supporting the involvement of PNs in HTN management, particularly in the role of care coordinators. The abstract indicates that PN-led or PN-supported management could both improve patient outcomes and free GP time, though specific outcomes, magnitudes of effect, or study-level findings are not provided in the abstract.
Despite the favourable evidence for PN involvement, the review emphasises that institutional barriers remain. These include the absence of nationally agreed remits and working practices for new or expanded PN roles, which limits implementation and scaling of PN-led HTN management in primary care.
The abstract does not list specific institutional barriers beyond lack of role clarity and standardisation, nor does it report on regulatory, training, funding, or governance mechanisms — such details are not reported in the source abstract.
From the abstracted findings, practice-level implications include considering expanded PN roles for HTN care as a strategy to address diagnostic and treatment gaps and to alleviate GP workload. Implementation would likely require clearer role definitions, agreed remits, and standardised working practices at a national level.
The review indicates a need to address institutional obstacles before PN-led HTN management can be widely adopted. Specific recommendations for training, evaluation, or policy change are not detailed in the abstract; these would need to be consulted in the full article for guidance on operationalising PN roles in hypertension care.
Note: The abstract provides an overview of aims, methods and high-level findings. Further details on included studies, effect sizes, specific interventions, and implementation examples were not reported in the abstract and would require access to the full text for comprehensive appraisal.