Non-pharmacological interventions for older adults with comorbid hypertension and type 2 diabetes: A systematic...

Multimorbidity is rising and comorbid hypertension and type 2 diabetes is the most common among older adults. Although pharmacological therapy is the mainstay, non-pharmaceutical interventions are essential for disease control. We conducted a systematic review to synthesize evidence from randomized controlled trials in older adults on non-pharmacological approaches by intervention strategy and delivery setting.

Following PRISMA 2020, we searched PubMed, Embase, and Cochrane CENTRAL (until October 2024) for randomized controlled trials enrolling adults ≥60 years with both conditions. Risk of bias was assessed with RoB 2; heterogeneity precluded meta-analysis and findings were synthesized narratively.

A total of 3449 studies were screened, and 16 trials were included in final analyses. Interventions were classified as exercise (n = 3), diet (n = 2), self-monitoring (n = 1), multi-strategy (n = 3), or comprehensive lifestyle modification (n = 7), delivered via hospital (n = 6), community (n = 6), or telehealth (n = 4) models. Most trials (∼75%) reported a statistically significant effect on their prespecified primary outcomes, mainly blood pressure or HbA1c. Effects were most consistent for comprehensive lifestyle modification, especially those combining individualized planning with technology-assisted support. By setting, hospital interventions tended to yield short-term physiological gains, whereas community and telehealth models emphasized adherence and sustained engagement. Only two trials included post-intervention follow-up.

Comprehensive behaviorally informed interventions combining individualized planning with technology-assisted support were the most effective for older adults with hypertension and diabetes multimorbidity. Studies targeting this population remain limited with no long-term follow-up. Innovations in strategy optimization and adaptation to contexts and assessment of sustained effects are needed in multimorbidity management.