Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis

Abstract

Objective:To synthesize the evidence for using interactive digital interventions (IDIs) to support patient self-management of hypertension, and to determine their impact on control and reduction of blood pressure.Method:Systematic review with meta-analysis was undertaken with a search performed in MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The population was adults (>18 years) with hypertension, intervention was an IDI and the comparator was usual care. Primary outcomes were change in SBP and DBP. Only randomized controlled trials and studies published in journals and in English were eligible. Eligible IDIs included interventions accessed through a computer, smartphone or other hand-held device.Results:Four out of seven studies showed a significantly greater reduction for intervention compared to usual care for SBP, with no difference found for three. Overall, IDIs significantly reduced SBP, with the weighted mean difference being −3.74 mmHg [95% confidence interval (CI) −2.19 to −2.58] with no heterogeneity observed (I-squared = 0.0%, P = 0.990). For DBP, four out of six studies indicated a greater reduction for intervention compared to controls, with no difference found for two. For DBP, a significant reduction of −2.37 mmHg (95% CI −0.40 to −4.35) was found, but considerable heterogeneity was noted (I-squared = 80.1%, P = <0.001).Conclusion:IDIs lower both SBP and DBP compared to usual care. Results suggest these findings can be applied to a wide range of healthcare systems and populations. However, sustainability and long-term clinical effectiveness of these interventions remain uncertain.

Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction (Preprint)

“…Notably, this result was in accordance with other studies using mobile and other similar older technologies [11,46]. In one metaanalysis, a decrease of 5 mm Hg in DBP or 10 mm Hg in SBP was found to reduce coronary heart disease events by 22% and stroke by 41% [47], as a decrease of 1 mm Hg in SBP leads to a 5% reduction in the risk of stroke [46]. The findings of this review are in line with other systematic reviews that involved smartphone and tablet based intervention in managing chronic diseases, which showed that the use of apps has the potential to improve health outcomes among those living with chronic diseases [8,10,11,49,50].…”

“…Notably, this result was in accordance with other studies using mobile and other similar older technologies [11,46]. In one metaanalysis, a decrease of 5 mm Hg in DBP or 10 mm Hg in SBP was found to reduce coronary heart disease events by 22% and stroke by 41% [47], as a decrease of 1 mm Hg in SBP leads to a 5% reduction in the risk of stroke [46].…”

Adherence to Antihypertensive Therapy

“…A recent meta-analysis of interactive digital interventions demonstrated that interactive digital interventions are effective in lowering both SBP (weighted mean difference [WMD] −3.74 mm Hg, 95% confidence interval [CI] −5.28 to −2.19) and DBP (WMD −2.37 mm Hg, 95% CI −4.35 to −0.40) compared with usual care. 75 Few studies in the review included medication adherence as an outcome measure. Despite the promising results, little is known about the sustainability, long-term effectiveness, and active components of these interventions; thus, the evidence is not robust enough to warrant a policy or practice change at this time.…”

Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial

“…33 There is accumulating evidence that DIs can deliver better and more efficient healthcare in the context of hypertension, 34 35 confirmed by a recent systematic review and meta-analysis undertaken by our team. 36 Therefore, the HOME BP programme has been developed to incorporate previously identified effective intervention components (self-monitoring, preplanned medication titrations and behavioural support) delivered in an acceptable and feasible online format.…”