Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments

Abstract

Background Hypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension. Methods We searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted. Results Thirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients’ metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was − 5.34 mmHg (95% confidence interval [CI], − 7.35 to − 3.33) and in diastolic blood pressure was − 3.23 mmHg (95% CI, − 5.51 to − 0.96). Conclusions Interventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.

Effect of an Educational Intervention on Lifestyle Modification of Patients With Hypertension at Bishoftu General Hospital, Ethiopia, 2021

“…The lifestyle factors our intervention focused on were similar to those in the report, including reducing salt intake, increasing consumption of fruits and vegetables, increasing physical activity, avoiding alcohol, and medication adherence. Our results were consistent with findings from previous studies in high-income and upper-middle-income countries ( 8 ) and add to the evidence on the effectiveness of interventions using education and counseling strategies in CVD prevention and control in a particular context of low-income countries.…”

“…Education and counseling interventions have been proven effective in preventing and controlling hypertension ( 7 , 8 ). This type of behavioral intervention includes lifestyle modifications such as promoting physical activity, a healthy diet, smoking cessation, and adherence to medication.…”

The impact of population screening for cardiovascular disease on quality of life

“…This design originates from social science but is increasingly recognized also in CVD. 32 Unbiased estimates of the possible harm of screening are of high importance for ethical as well as for health policy reasons as decision-makers are increasingly considering the evidence for cost-effectiveness based on quality-adjusted life years (QALY). The QALY typically captures the benefit of screening by the mortality risk reduction whereas the harm to HRQoL is much less straightforward because it may fluctuate over time as individual events are faced.…”

Improving Hypertension Control in the Black Patient Population

“…4 Evidence-based strategies include education and self-monitoring of blood pressure (SMBP), 5 in conjunction with taking evidencebased medications, maintaining physical activity, and incorporating diet and lifestyle changes into everyday routines. 6,7 Reasons for health inequities in the care of Black patients with uncontrolled HTN include, in part, systemic and structural barriers that prevent equitable access to education, resources, and care providers. 8 The result is persistent, uncontrolled BP (defined as an average systolic blood pressure [SBP] >140 mm Hg or an average diastolic blood pressure [DBP] >90 mm Hg among those with HTN) 9 and an associated increased risk of stroke and death.…”

“…Although evidence-based care delivery strategies to reduce BP are well-known, these are not implemented consistently in the Black population 4. Evidence-based strategies include education and self-monitoring of blood pressure (SMBP),5 in conjunction with taking evidence-based medications, maintaining physical activity, and incorporating diet and lifestyle changes into everyday routines 6,7. Reasons for health inequities in the care of Black patients with uncontrolled HTN include, in part, systemic and structural barriers that prevent equitable access to education, resources, and care providers 8.…”