Healthcare professional-led interventions on lifestyle modifications for hypertensive patients - a systematic review and meta-analysis

Abstract

Background: About 0.9 billion people in the world have hypertension. The mortality due to hypertension increased dramatically over the last decades. Healthcare professionals should support patients with hypertension to modify their lifestyle to decrease blood pressure, but an overview of effective lifestyle interventions is lacking. The aim of this study was to determine whether healthcare professional-led interventions on lifestyle modifications are effective in lowering blood pressure in patients with hypertension.

Methods: A systematic literature review following the PRISMA guidelines was conducted. PubMed, EMBASE and CINAHL databases were searched for randomized control trials (RCTs) of interventions on lifestyle modifications of hypertensive patients which were performed by healthcare professionals (physician, nurse, pharmacist) and which reported blood pressure measurements. Papers were reviewed by two reviewers and analysed using Cochrane software Revman 5.4. In a meta-analysis difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and the percentage of patients with controlled blood pressure (BP) was analysed.

Results: In total, 34 clinical trials reporting on 22,419 patients (mean age 58.4 years, 49.14% female, 69.9% used antihypertensive medications) were included. The mean difference SBP was - 4.41 mmHg (95% CI, - 5.52to - 3.30) and the mean difference DBP was - 1.66 mmHg (95% CI - 2.44 to - 0.88) in favor of the intervention group vs usual care. Fifty-six percent of patients achieved BP control in the intervention group vs 44% in usual care, OR = 1.87 (95% CI, 1.51 to 2.31).

Conclusion: Healthcare professional-led interventions were effective. Patients achieved almost 5 mmHg decrease of SBP and more patients achieved BP control. The results suggest that efforts are needed for widespread implementation.

Keywords: Blood pressure; Health care professionals; Hypertension; Lifestyle; Non-pharmacological intervention.

Fig. 1

Flow diagram. Unique articles were identified from database searching. Articles were screened against eligibility criteria in two rounds by two independent authors. First screening by title and abstracts was carried out. Then after discussion, full text records were retrieved and screened against eligibility criteria independently and discussed again

Fig. 2

Overall assessment of the biases of included studies. Nine criteria for the assessment of risk of bias were used. Biases were assigned to one of the three categories – low risk, unclear risk and high risk

Fig. 3

Subgroup analyses of the effect of interventions by baseline systolic blood pressure. Legend: Forest plot shows difference in systolic blood pressure change between patients with baseline systolic blood pressure over 150 mmHg versus patients with baseline systolic blood pressure lower than 150 mmHg; forest plot was created using RevMan 5.4; SBP – systolic blood pressure, CI – confidence interval, SD – standard deviation; small green squares represent difference in SBP reduction of individual RCTs, horizontal lines show 95% CI, black diamonds represent difference in SBP reduction within subgroup and total. Statistically significant difference was found comparing subgroups (P = 0.04)

Fig. 4

Subgroup analyses of the effect of interventions by different healthcare professionals. Forest plot shoes difference in systolic blood pressure change after interventions provided by different healthcare professionals individually (pharmacist, nurse or physician) or team, consisting of different healthcare professionals; forest plot was created using RevMan 5.4; CI – confidence interval, SD – standard deviation; small green squares represent difference in SBP reduction of individual RCTs, horizontal lines show 95% CI, black diamonds represent difference in SBP reduction within subgroup and total. No statistically significant difference was found between subgroups