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- Title
Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis.
- Authors
Mills, Katherine T.; Obst, Katherine M.; Shen, Wei; Molina, Sandra; Zhang, Hui-Jie; He, Hua; Cooper, Lisa A.; He, Jiang
- Abstract
<bold>Background: </bold>The prevalence of hypertension is high and is increasing worldwide, whereas the proportion of controlled hypertension is low.<bold>Purpose: </bold>To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension.<bold>Data Sources: </bold>Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches.<bold>Study Selection: </bold>Randomized controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension.<bold>Data Extraction: </bold>Two investigators independently extracted data and assessed study quality.<bold>Data Synthesis: </bold>A total of 121 comparisons from 100 articles with 55 920 hypertensive patients were included. Multilevel, multicomponent strategies were most effective for systolic BP reduction, including team-based care with medication titration by a nonphysician (-7.1 mm Hg [95% CI, -8.9 to -5.2 mm Hg]), team-based care with medication titration by a physician (-6.2 mm Hg [CI, -8.1 to -4.2 mm Hg]), and multilevel strategies without team-based care (-5.0 mm Hg [CI, -8.0 to -2.0 mm Hg]). Patient-level strategies resulted in systolic BP changes of -3.9 mm Hg (CI, -5.4 to -2.3 mm Hg) for health coaching and -2.7 mm Hg (CI, -3.6 to -1.7 mm Hg) for home BP monitoring. Similar trends were seen for diastolic BP reduction.<bold>Limitation: </bold>Sparse data from low- and middle-income countries; few trials of some implementation strategies, such as provider training; and possible publication bias.<bold>Conclusion: </bold>Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control.<bold>Primary Funding Source: </bold>National Institutes of Health.
- Subjects
THERAPEUTICS; HYPERTENSION; PATIENTS; REGULATION of blood pressure; DISEASES in adults; RANDOMIZED controlled trials; MEDICAL information storage &; retrieval systems; MEDLINE; META-analysis; SYSTEMATIC reviews; HUMAN services programs; ADULTS; PREVENTION
- Publication
Annals of Internal Medicine, 2018, Vol 168, Issue 2, p110
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M17-1805