<![CDATA[Introduction: Hypertension control remains critically low in geographically isolated and disadvantaged areas (GIDAs), where nurses are the primary healthcare providers. Despite growing evidence on hypertension interventions, fragmentation in recognizing barriers specific to nursing practice in GIDAs persists. This review synthesizes the nursing challenges and system-level barriers to hypertension management in GIDAs. Methods: A mixed-methods systematic review following the PRISMA 2020 guidelines searched five databases (Scopus, PubMed, Web of Science, CINAHL, and ScienceDirect) from January 1, 2010, to January 31, 2025. Quality appraisal was performed using the MMAT version 2018. Thematic analysis was performed following Braun and Clarke. Results: Of 2,294 records, 33 studies met the inclusion criteria. Most (78.8%) were from LMICs, predominantly South Asia (n = 10) and Sub-Saharan Africa (n = 9). Quality appraisal rated 15 studies (45.5%) as high-quality, 17 (51.5%) as moderate, and 1 (3.0%) as low. Five interrelated domains were identified: (1) geographic isolation and transport burden (27/33); (2) fragmented health systems and insurance barriers (23/33); (3) low health literacy and limited self-management (21/33); (4) culturally incongruent interventions (17/33); and (5) limited implementation and scalability (15/33). Task-shifting and nurse-led partnerships achieved systolic blood pressure reductions of 5–12 mmHg and improved medication adherence, yet they remain underutilized in GIDA settings. Conclusions: Nursing practice is central to addressing hypertension inequities in GIDAs. Strengthening community-based nursing, integrating cultural adaptation, and expanding implementation research are crucial for equitable hypertension management.]]>
