Background
Methods
Inclusion and exclusion criteria
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Were randomized controlled clinical trials (RCTs);
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Involved patients with a diagnosis of hypertension or with an elevated blood pressure above 140/90 mmHg or 130/80 for patients with diabetes [17];
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Evaluated an intervention led by a healthcare professional which consisted of one or more individual consultations on lifestyle modification, health promotion or non-pharmaceutical management, targeting blood pressure.
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Were non-English articles;
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Interventions performed in group sessions;
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Consisted of pharmacological interventions only;
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Interventions that included less than 10 patients in either intervention or control group
Outcome measures
Data collection and analysis
Data synthesis and subgroup analysis
Results
The description of studies
Study design | Country | Trial length in month | Number of patients included | Proportion of patients under BP control % | Diastolic BP at recruitment, mmHg | Systolic BP at recruitment, mmHg | Patients with diabetes % | Female % | Mean age | Race | Proportion using antihypertensive medication, % | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Artinian 2007 | RCT | USA | 8 | 387 | 0 | > = 90 | > = 140 | 25.83 | 64.34 | 59.65 | 100% African Americans | 70.54 |
Borenstein 2003 | RCT | USA | 12 | 197 | 0 | > = 90 | > = 140 | 13 | 61 | 62 | 32% African Americans | N/A |
Bosworth 2009 | RCT | USA | 24 | 636 | 73 | di | di | 36 | 66 | 61 | 49% African Americans | 100 |
Bosworth 2011 | RCT | USA | 18 | 591 | 59 | > 90 | > 140 | 43 | 8 | 64 | 48% white | 100 |
Brennan 2010 | RCT | USA | 12 | 638 | 14 | di | di | 26 | 67 | 55.7 | 100% African Americans | 96 |
Garcia-Pena 2001 | RCT | Mexico | 6 | 718 | 0 | > = 90 | > = 160 | 26 | 64 | 70.6 | N/A | 77 |
Green 2008 | RCT | USA | 12 | 778 | 0 | 90–109 | 140–199 | N/A | 52.2 | 59.1 | 82,8% white | 96 |
Hennessy 2006 | cRCT | USA | 6 | 10,696 | 53.29 | di | di | 25.48 | 56.95 | 62.3 | 48% Caucasian | 66.77 |
Hunt 2004 | RCT | USA | 12 | 604 | 0 | 90–99 | 140–159 | 15 | 58 | 69 | 90% white | N/A |
Hunt 2008 | RCT | USA | 12 | 463 | 0 | > = 100 | > = 160 | 25 | 65 | 68 | N/A | N/A |
Johnson 2011 | RCT | USA | 6 | 552 | 0 | di | di | 43 | 65 | 42 | 91% African Americans | 96 |
Kastarinen 2002 | RCT | Finland | 24 | 715 | N/A | 90–109 | 140–179 | N/A | 53 | 54.3 | N/A | 52 |
Lang 1995 | cRCT | France | 18 | 129 | 0 | > 90 | > 140 | N/A | 5 | 43 | N/A | 19 |
Lee 2007 | RCT | Taiwan | 6 | 202 | 0 | N/A | 140–179 | N/A | 42 | 71.3 | N/A | 68 |
Little 2004 | cRCT | USA | 1 | 296 | 0 | > 90 | > 160 | N/A | 44 | 50 | N/A | 0 |
Ma 2014 | RCT | China | 6 | 120 | N/A | di | di | N/A | 50.83 | 58.76 | N/A | 100 |
Magid 2011 | RCT | USA | 6 | 338 | 0 | > 90 (80a) | > 140 (130a) | 54 | 35 | 65.4 | 65% white | 100 |
Margolis 2013 | cRCT | USA | 18 | 450 | 0 | > = 90 | > = 140 | 19.11 | 44.7 | 61.1 | 81.8 white | 73.8 |
McKenney 1973 | RCT | USA | 5 | 50 | 32 | > 90 | N/A | N/A | 76 | 60 | 78% African American | N/A |
McLean 2008 | RCT | Canada | 6 | 227 | 3 | > 80 | > 130 | 100 | 40 | 64.95 | N/A | 66.95 |
Mehos 2000 | RCT | USA | 6 | 36 | 0 | 90–109 | 140–179 | 19.44 | 69.44 | 58.8 | 77.77 Caucasian | 100 |
Morgado 2011 | RCT | Portugal | 9 | 197 | 33 | di | di | 18 | 60 | 59.5 | N/A | 100 |
Roumie 2006 | cRCT | USA | 6 | 1827 | 0 | > = 90 | > 140 | 4.02 | 3 | 65 | N/A | 100 |
Saleem 2015 | RCT | Pakistan | 9 | 385 | 41.8 | di | di | N/A | 31.2 | 39 | N/A | 100 |
Sookaneknun 2004 | RCT | Thailand | 6 | 235 | 20.42 | > = 90 | > = 140 | 44 | 68 | 63.2 | N/A | N/A |
Stewart 2005 | RCT | South Africa | 6 | 83 | N/A | di | di | N/A | N/A | N/A | N/A | N/A |
Tobari 2010 | RCT | Japan | 6 | 132 | 38.63 | 90–109 | 140–179 | N/A | 34 | 61.65 | N/A | 94 |
Tonstad 2007 | RCT | Norway | 6 | 49 | 0 | 90–99 | 140–169 | N/A | 26.53 | 55 | N/A | 16.32 |
Vivian 2002 | RCT | USA | 6 | 56 | 0 | > 90 | > 140 | 51 | 0 | 64.75 | 77.4% African American | 100 |
Wakefield 2011 | RCT | USA | 6 | 302 | N/A | di | di | 100 | 2 | 68 | 96% Caucasian | N/A |
Wal 2013 | RCT | India | 6 | 142 | 0 | > 90 | > 140 | 40.19 | 55.88 | 60.06 | N/A | N/A |
Woollard 1995 | RCT | Australia | 4.5 | 166 | N/A | di | di | N/A | 46.57 | 58.3 | N/A | 100 |
Zabler 2018 | RCT | China | 6 | 59 | N/A | di | di | N/A | 63 | 53.73 | 100% African American | 100 |
Zhu 2017 | RCT | USA | 4 | 134 | 0 | > = 90 | > 140 | 23.9 | 50.7 | 69 | N/A | 81 |
Zillich 2005 | cRCT | USA | 3 | 125 | 0 | di | di | 28 | 61 | 65 | 97.6% white | 100 |
Intervention specialist | Outcome BP place | Tailored | Face-to face lifestyle management intervention | Specialist training | Components of the lifestyle intervention | Medication change referred or recommended | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Education on disease | Lifestyle advice not specified | Dietary (Na restriction) | Dietary/weight loss/DASH | Alcohol consumption | Smoking cessation | Exercise/physical activity | Adherence improvement strategies c | Education on home blood pressure monitoring | |||||||
Artinian 2007 | Nurse | Office | No | No | + | + | + | ||||||||
Borenstein 2003 | Team | Office | No | Yes | + | + | + | + | + | + | |||||
Bosworth 2009 | Nurse | Office | No | No | + | + | + | + | + | + | |||||
Bosworth 2011 | Nurse | Office | Yes | No | + | + | + | + | + | + | + | ||||
Brennan 2010 | Nurse | Home | No | No | + | + | + | + | + | + | |||||
Garcia-Pena 2001 | Nurse | Home | No | Yes | + | + | + | + | + | + | |||||
Green 2008 | Pharmacist | Office | Yes | No | + | + | + | + | + | ||||||
Hennessy 2006 | Providera | Office | No | No | + | + | + | ||||||||
Hunt 2004 | Primary care provider | Office | No | No | + | + | + | + | |||||||
Hunt 2008 | Team | Office | Yes | Yes | + | + | + | ||||||||
Johnson 2011 | Nurse | Office | No | Yes | + | + | + | + | + | + | + | ||||
Kastarinen 2002 | Nurse | Office | No | Yes | + | + | + | + | + | + | |||||
Lang 1995 | Physician | Office | No | Yes | + | + | |||||||||
Lee 2007 | Nurse | Office | No | Mixed | + | ||||||||||
Little 2004 | Nurse | Home | No | Yes | + | + | + | + | + | + | + | + | |||
Ma 2014 | Nurse | Office | No | Yes | + | + | + | + | + | + | |||||
Magid 2011 | Pharmacist | Office | Yes | No | + | + | + | + | |||||||
Margolis 2013 | Pharmacist | Office | No | Mixed | + | + | + | + | |||||||
McKenney 1973 | Pharmacist | Office | No | Yes | + | + | + | ||||||||
McLean 2008 | Team | Office | No | Yes | + | + | + | ||||||||
Mehos 2000 | Pharmacist | Office | Yes | Mixed | + | + | + | + | + | + | + | ||||
Morgado 2011 | Pharmacist | Office | No | yes | + | + | + | ||||||||
Roumie 2006 | Providerb | Office | No | No | + | + | + | + | + | ||||||
Saleem 2015 | Pharmacist | Office | No | Yes | + | + | + | + | |||||||
Sookaneknun 2004 | Pharmacist | Office | No | Yes | + | + | + | + | + | + | + | + | |||
Stewart 2005 | Physician | Office | No | No | + | + | + | + | |||||||
Tobari 2010 | Team | Home/office | No | Yes | + | + | + | + | + | + | + | + | + | ||
Tonstad 2007 | Nurse | Office | No | Yes | + | + | + | + | + | ||||||
Vivian 2002 | Pharmacist | Office | No | Yes | + | + | + | ||||||||
Wakefield 2011 | Nurse | nn | Yes | No | + | + | + | + | + | ||||||
Wal 2013 | Pharmacist | Office | No | Yes | + | + | + | + | + | + | |||||
Woollard 1995 | Nurse | Office | No | Yes | + | + | + | + | + | ||||||
Zabler 2018 | Nurse | Office | No | Mixed | + | + | |||||||||
Zhu 2017 | Nurse | Office | Yes | Mixed | + | + | + | + | + | + | |||||
Zillich 2005 | Team | Office | No | Yes | + | + | + | + |
Systolic blood pressure
Subgroups | Mean difference SBP mmHg (95% CI) | P value1 | |
---|---|---|---|
Duration of intervention | 6 months and under | Over 6 months | |
−4.34 (−6.13 to −2.54) | −4.58 (−5.94 to −3.22) | P = 0.83 | |
Place of blood pressure measurement | Home | Physician’s office/clinic | |
−2.85 (−4.66 to −1.04) | −4.50 (−5.74 to −3.26) | P = 0.14 | |
Tailored intervention | Tailored | Not tailored | |
−4.40 (−7.19 to −1.60) | −4.37 (−5.58 to −3.15) | P = 0.99 | |
Medication adherence improvement techniques | Used | Not used | |
−4.34 (− 5.91 to − 2.78) | −4.48 (− 6.09, − 2.88) | P = 0.90 | |
Referral for medication change or adjustment | Included | Not included | |
−4.46 (−6.21 to − 2.71) | −4.40 (− 5.85 to − 2.96) | P = 0.96 |
Diastolic blood pressure
Blood pressure control
Subgroups | OR (95% CI) | P value2 | |
---|---|---|---|
Duration of intervention | 6 months and under | Over 6 months | |
1.64 (1.24 to 2.16) | 2.14 (1.60 to 2.87) | P = 0.19 | |
Baseline systolic blood pressure | Below 150 mmHg | Over 150 mmHg | |
1.51 [1.17, 1.96] | 2.27 [1.83, 2.81] | P = 0.02 | |
Healthcare provider | Single (pharmacist, nurse or physician alone) | Team | |
1.96 [1.47, 2.62] | 1.81 [1.38, 2.36] | P = 0.68 | |
Tailored intervention | Tailored | Not tailored | |
1.94 (1.16 to 3.25) | 1.83 (1.44 to 2.32) | P = 0.84 | |
Medication adherence improvement techniques | Used | Not used | |
2.35 (1.62 to 3.42) | 1.65 (1.28 to 2.11) | P = 0.12 | |
Referral for medication change or adjustment | Included | Not included | |
1.77 [1.41, 2.21] | 2.06 [1.34, 3.16] | P = 0.54 |