Comparative effectiveness of lifestyle interventions for prehypertension: A network meta-analysis of randomized controlled trials

Abstract

This study aims to compare the effectiveness of lifestyle interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in individuals with prehypertension. A systematic literature search was conducted in PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and the Wanfang database from inception to December 2023. The analysis included randomized controlled trials with either parallel or cross-over designs. Utilizing a Bayesian network meta-analysis approach, we included 67 studies evaluating 17 lifestyle interventions compared with control. For SBP, dietary supplement plus exercise was the most effective lifestyle intervention, with a mean difference (MD) of -14.86 (95 % credible interval [CrI] -20.44 to -9.35). For DBP, health education plus meditation was the most effective lifestyle intervention (MD -13.99, 95 % CrI -22.25 to -5.65). Subgroup analyses showed that the effectiveness of the interventions varied by duration, age, and economic level of the region. This study underlines the importance of dietary factors and exercise in the management of prehypertension and highlights the superiority of multi-component lifestyle interventions. However, the effectiveness of these interventions varies based on participant characteristics and intervention type, emphasizing the need for tailored, population-specific approaches.

Keywords: Comparative effectiveness; Lifestyle intervention; Network meta-analysis; Prehypertension.

Graphical abstract

Fig. 1

Flowchart for searching and selecting eligible studies.

Fig. 2

Risk of bias assessment as a percentage.

Fig. 3

Network plot and forest plot of SBP outcome. (A) network plot, each node corresponds to a specific lifestyle intervention, with "CO" denoting the control intervention. the nodes represent lifestyle interventions, the node size represents the number of studies, the lines represent the number of direct comparisons between lifestyle interventions. (B) forest plot was used to compare the effect sizes of lifestyle interventions relative to the control group. Abbreviations: SBP, systolic blood pressure; DS, dietary supplement; EX, exercise; HE, health education; LSM, lifestyle modification; GHD, general healthy diet; DASH, dietary approaches to stop hypertension; MA, massage; PC, psychological care; ME, meditation; RT, relaxation therapy; TEAS, transcutaneous electrical stimulation of acupuncture points; CO, control; CrI, credible interval.

Fig. 4

Network plot and forest plot of DBP outcome. (A) network plot, each node corresponds to a specific lifestyle intervention, with "CO" denoting the control intervention. the nodes represent lifestyle interventions, the node size represents the number of studies, the lines represent the number of direct comparisons between lifestyle interventions. (B) forest plot was used to compare the effect sizes of lifestyle interventions relative to the control group. Abbreviations: DBP, diastolic blood pressure; DS, dietary supplement; EX, exercise; HE, health education; LSM, lifestyle modification; GHD, general healthy diet; DASH, dietary approaches to stop hypertension; MA, massage; PC, psychological care; ME, meditation; RT, relaxation therapy; TEAS, transcutaneous electrical stimulation of acupuncture points; CO, control; CrI, credible interval.

Fig. 5

Subgroup analyses of SBP outcome. Abbreviations: SBP, systolic blood pressure; DS, dietary supplement; EX, exercise; HE, health education; LSM, lifestyle modification; GHD, general healthy diet; DASH, dietary approaches to stop hypertension; MA, massage; PC, psychological care; ME, meditation; RT, relaxation therapy; TEAS, transcutaneous electrical stimulation of acupuncture points; CO, control; CrI, credible interval; LMICs, low- and middle-income countries.

Fig. 6

Subgroup analyses of DBP outcome. Abbreviations: DBP, diastolic blood pressure; DS, dietary supplement; EX, exercise; HE, health education; LSM, lifestyle modification; GHD, general healthy diet; DASH, dietary approaches to stop hypertension; MA, massage; PC, psychological care; ME, meditation; RT, relaxation therapy; TEAS, transcutaneous electrical stimulation of acupuncture points; CO, control; CrI, credible interval; LMICs, low- and middle-income countries.