Primary care clinician education interventions for improving blood pressure control for people prescribed antihypertensive treatment: a systematic review and meta-analysis.

Abstract

Half of people treated for hypertension are not controlled to target; clinician education may improve effective antihypertensive use. To systematically review and synthesise evidence from 2010 to 2024 on primary care clinician education interventions for improving blood pressure (BP) control in people on antihypertensive treatment. Systematic literature review. MEDLINE, Embase and CINAHL were searched in January 2024. Primary care. Primary care clinicians and patients with hypertension. Randomised controlled trials from 2010 to 2024 of clinician education interventions, based in primary care and reporting BP change pre-intervention versus post-intervention, were included. The primary outcome was post-intervention difference in systolic BP (SBP). The secondary outcome was change in the proportion of participants with BP controlled to target. Abstracts were screened by four researchers; then, data were extracted from selected studies using a pre-designed proforma. Bias was assessed using the Cochrane collaboration's risk of bias tool. Results were synthesised using meta-analysis and intervention content was narratively analysed. A total of 73 full-text articles were screened for eligibility, of which 5 met the inclusion criteria. Meta-analysis showed no evidence of benefit (SBP reduction of -1.24 mm Hg (95% CI -3.95 to 1.47)). Of note, all bar one study reported inconclusive results. Further analysis of included studies suggested that benefit may be more likely for interventions of longer duration, involving more frequent follow-up and targeting higher risk patients. Current available evidence indicates clinician education interventions are unlikely to improve BP control in primary care when used in isolation.