Quality of clinical reports on behavioral interventions for hypertension

The purpose of this study was to provide clinicians with the confidence to employ behavioral interventions for hypertension and to guide researchers in the development and reporting of studies.

We systematically reviewed English language articles (1970-1999) describing behavioral interventions for hypertension, evaluating aspects of design, analysis, reporting of results, and factors that were associated with higher quality of these studies.

Of 100 articles, 49 were randomized controlled trials (RCT), 33 were observational studies with control groups, and 18 were observational studies without control groups; mean (SE) quality scores were 69.2 (1.6), 57.6 (5.3), and 60.3 (2.2), respectively. RCTs were more likely than observational studies to attain high scores in descriptions of appropriateness of control group, inclusion and exclusion criteria, study population, and the intervention protocol. In multivariate analysis, date of publication, reported funding source, and intervention type were independently associated with greater quality scores: 7.4 [95% CI: 0.03, 14.7] points greater for articles published 1990-1999 vs 1970-1979, 6.5 [95% CI: 1.4, 11.6] points greater for articles reporting government funding vs those not reporting funding sources, and 8.6 [95% CI: 0.3, 17.1], 12.9 [95% CI: 3.4, 22.4], and 14.2 [4.1, 24.4] points greater for articles examining patient education/support, change in delivery system, and mass health campaigns vs articles examining patient reminders, respectively.

While quality has improved over time, there is considerable room for improvement. Investigators should pay particular attention to description of study population and allocation of subjects, the use of standardized outcomes reporting, and appropriate statistical analysis.