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Group-delivered interventions for lowering blood pressure in hypertension: a systematic review and meta-analysis
Sinéad Tj McDonagh1, Charlotte Reburn1, Jane R Smith1
1Exeter Collaboration for Academic Primary Care, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter.
Insights
Group interventions effectively lower blood pressure (BP) in hypertensive patients compared to usual care. Exercise and lifestyle education showed the most significant BP reductions, highlighting their potential in primary care settings.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Clinical Trials
Background:
- Hypertension is a leading modifiable risk factor for cardiovascular disease, with current primary care management often suboptimal.
- Group-delivered interventions, incorporating peer support, offer a potentially efficient approach to managing hypertension in primary care.
- The evidence base for the effectiveness of group interventions in hypertension management remains unclear.
Purpose of the Study:
- To systematically evaluate the impact of group-delivered hypertension interventions on blood pressure (BP) outcomes compared to usual care (UC).
- To identify which types of group interventions are most effective in lowering BP.
- To explore factors associated with greater BP reductions in group settings.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searches included MEDLINE, Embase, Cochrane CENTRAL, and CINAHL up to March 2024.
- Data from 54 studies (13,976 participants) were pooled using random-effects meta-analyses, with meta-regression used to identify predictors of BP lowering.
Main Results:
- Group interventions significantly reduced systolic BP by 7.2 mmHg (exercise), 4.8 mmHg (lifestyle education), and 3.6 mmHg (psychotherapeutic interventions) compared to UC.
- Diastolic BP reductions were also observed: 3.9 mmHg (exercise), 2.9 mmHg (lifestyle education), and 1.2 mmHg (psychotherapeutic interventions).
- Higher baseline BP and pre-existing cardiovascular morbidity were associated with greater BP reductions.
Conclusions:
- Group-delivered interventions demonstrate effectiveness in lowering blood pressure for individuals with hypertension.
- Exercise and lifestyle education interventions appear particularly beneficial.
- Further research is needed to assess the feasibility and cost-effectiveness of these interventions in primary care.
Background:
Hypertension is the leading modifiable cause of cardiovascular disease. Primary care management is predominantly individual and remains suboptimal. Interventions delivered to groups incorporate peer support and potentially offer efficient use of limited resources. Evidence for the benefits of group-delivered interventions in hypertension is unclear.
Aim:
To determine whether group-delivered hypertension interventions improve blood pressure (BP) outcomes compared to usual care (UC).
Design And Setting:
Systematic review, meta-analyses, and meta-regression of randomised controlled trials in community, primary, or outpatient care settings.
Method:
MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched from inception to 20 March 2024 for randomised controlled trials comparing group-delivered interventions to UC for adults with hypertension. Primary outcomes were changes in systolic and diastolic BP, achievement of study BP targets and medication adherence; quality was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled according to intervention type using random effects meta-analyses; predictors of BP lowering were modelled with meta-regression.
Results:
Overall, 5326 citations were retrieved; 59 intervention groups (IGs) from 54 studies (13 976 participants) were included. Compared to UC, systolic BP reduced by 7.2 mmHg (95% confidence interval [CI] = 4.7 to 9.6; 23 IGs) following exercise, 4.8 mmHg (95% CI = 3.2 to 6.4; 26 IGs) following lifestyle education, and 3.6 mmHg (95% CI = 0.3 to 6.9; seven IGs) following psychotherapeutic interventions. Corresponding reductions in diastolic BP were 3.9 mmHg (95% CI = 2.6 to 5.2; 21 IGs), 2.9 mmHg (95% CI = 1.8 to 3.9; 24 IGs), and 1.2 mmHg (95% CI = -1.9 to 4.3; seven IGs). Achievement of target BP and medication adherence were infrequently reported, with equivocal findings (relative risks 1.1, 95% CI = 1.0 to 1.2, P = 0.02, 11 IGs and 1.0, 95% CI = 1.0 to 1.1, P = 0.60, seven IGs, respectively). In multivariable models, higher baseline BP and pre-existing cardiovascular morbidity were associated with greater BP reductions.
Conclusion:
Group-delivered interventions were effective at lowering BP for people with hypertension compared with UC; their feasibility and cost-effectiveness in primary care require further study.
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