Clark et al. Nurse-led interventions used to improve control of high blood pressure in people with diabetes: a systematic review and meta analysis

We are writing with respect to the above article. Clark et al. seem confused about the term ‘nurse prescribing’. These authors recently published a systematic review of nurse-led interventions for improved control of hypertension [1] and this paper, a subgroup analysis of the review, presents findings for nurse-led interventions to control blood pressure in people with diabetes mellitus.

Clark et al. claim that five of the 11 studies reviewed included nurse prescribing in the intervention. However, at no stage do the authors in these studies mention or use the term ‘nurse prescribing’. The interventions provided by nurses in each of these five studies comprised lifestyle advice, education, support and the monitoring and titration of medicines. Importantly, the monitoring and titration of medicines was achieved by the use of locally agreed protocols, treatment algorithms and guidelines. Although Clark et al. refer to these activities as prescribing, they are not. Furthermore, nurses in the UK have only been able to prescribe medicines independently for hypertension since 2006 [2]. Four of the 11 studies reviewed by Clark et al. were undertaken in the UK prior to 2006. Given the above, it is impossible to see how Clark et al. have reached the conclusion that there is evidence of improved outcomes with nurse prescribers.