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Review
. 2023 Sep 23;15(9):e45834.
doi: 10.7759/cureus.45834. eCollection 2023 Sep.

Optimizing Antihypertensive Management for Hypertensive Patients With Secondary Complications: A Systematic Review and Meta-Analysis in Primary Care Settings

Sulaiman Althuwaikh  1 , Ibrahim Albassam  2 , Abdulrahaman Alrashed  3 , Fahad Alhaji  4 , Ahmed Al-Adawi  4 , Mohammed A Sindi  5 , Ahmad Alhibshi  6 , Ahmad Al Dehaini  1 , Layal Alqaysi  7
Affiliations
Review

Optimizing Antihypertensive Management for Hypertensive Patients With Secondary Complications: A Systematic Review and Meta-Analysis in Primary Care Settings

Sulaiman Althuwaikh et al. Cureus. .

Abstract

Despite significant pharmacological advancements, hypertension management remains challenging, with varying quality of primary care. Digital tools and other non-pharmacological interventions hold promise in addressing this challenge. Consequently, a thorough examination of these interventions is recommended. This meta-analysis focuses on clinician-oriented strategies aimed at improving hypertension management, to assess the most effective approaches for improving antihypertensive prescribing and blood pressure control for secondary prevention. This was done through a systematic review of randomized controlled trials published in PubMed and Embase since the beginning of 2010 that aimed to enhance antihypertensive medication prescription in primary care settings for hypertensive patients with secondary complications while reporting changes in blood pressure or target achievement. We screened 6305 records. Four studies met the inclusion criteria, with reported interventions including physician education and the implementation of electronic decision support systems. All studies showed that the control group had a statistically significant lower systolic blood pressure, but the effect on diastolic blood pressure was not statistically significant. The overall mean difference was 2.12 mmHg (95% CI = 0.98; 3.26, P-value = 0.0003) for systolic blood pressure in favor of the control group and 1.22 mmHg (95% CI = -0.48; 3.26, P-value = 0.16) for diastolic blood pressure, which was not statistically significant. Despite considerable efforts to control hypertension, it remains a significant obstacle to optimal cardiovascular risk reduction. This review is also limited by a scarcity of studies.

Keywords: blood pressure control; hypertension; primary care; secondary prevention; systematic review and meta-analysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Illustration of articles identification and screening steps.
Figure 2
Figure 2. Meta-analysis of systolic blood pressure control
Figure 3
Figure 3. Meta-analysis of diastolic blood pressure control
Figure 4
Figure 4. Risk of bias assessment of the included studies
See this image and copyright information in PMC

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