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Meta-Analysis
. 2024 Feb 5;7(2):e2356070.
doi: 10.1001/jamanetworkopen.2023.56070.

Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis

Miriam E Katz  1 , Reed Mszar  2 , Alyssa A Grimshaw  3 , Craig G Gunderson  4   5 , Oyere K Onuma  6 , Yuan Lu  7   8 , Erica S Spatz  4   7   8
Affiliations
Meta-Analysis

Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis

Miriam E Katz et al. JAMA Netw Open. .

Abstract

Importance: Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations.

Objective: To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities.

Data sources: In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023.

Study selection: Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

Data extraction and synthesis: Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model.

Main outcomes and measures: Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels.

Results: A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year.

Conclusions and relevance: In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lu reported receiving grants from the Sentara Research Foundation; the National Heart, Lung, and Blood Institute, National Institutes of Health; and the Patient-Centered Outcomes Research Institute outside of the submitted work. Dr Spatz reported receiving grants from the US Food and Drug Administration to support projects within the Yale University–Mayo Clinic Center of Excellence in Regulatory Science and Innovation and from the Patient Centered Outcomes Research Institute; the National Heart, Lung, and Blood Institute; the Centers for Disease Control and Prevention; the National Institute of Biomedical Imaging and Bioengineering; and the National Institute on Minority Health and Health Disparities, all for work unrelated to this study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart Depicting Study Methods in Accordance With the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guideline
Figure 2.
Figure 2.. Differences in Systolic Blood Pressure (SBP) Changes From Baseline to Follow-Up Time Points Between Digital Health Intervention and Control Groups
Random-effects restricted maximum likelihood model. Squares indicate mean SBPs, with horizontal lines indicating 95% CIs and the size of the squares representing weight; diamonds indicate pooled estimates, with outer points of the diamonds indicating 95% CIs.
Figure 3.
Figure 3.. Differences in Follow-Up Systolic Blood Pressure (SBP) Between Digital Health Intervention and Control Groups at Different Time Points
Random-effects restricted maximum likelihood model. Squares indicate mean SBPs, with horizontal lines indicating 95% CIs and the size of the squares representing weight; diamonds indicate pooled estimates, with outer points of the diamonds indicating 95% CIs.
See this image and copyright information in PMC

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