A Systematic Review On Lifestyle Change Interventions Performed By Health Care Professionals Targeting Blood Pressure In Hypertensive Patients

Abstract

About 0.9 billion people in the world have hypertension. The annual death rate due to hypertension increased by 51% from 1990 to 2015. The challenge is to provide an effective pharmacological and nonpharmacological intervention.Objectives: As modifications of lifestyle are essential in decreasing blood pressure and lowering cardiovascular disease risk, the aim of this study was to determine if health care professional-led interventions/recommendations on life style are effective in lowering blood pressure in patients with hypertension. Methods: A systematic literature review following PRISMA guidelines was carried out. We searched PubMed, EMBASE and CINAHL for RCT of life style interventions performed by health care professionals (physician, nurse, pharmacist) targeting blood pressure in hypertensive patients. Papers were reviewed by two reviewers and analyzed using Cochrane software Revman 5.2. Outcomes for the meta-analysis were Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and number of patients under blood pressure (BP) control. Results: A total of 32 clinical trials with the recommendation on life style change like diet, smoking cessation, physical activity etc. were included. In the included studies 22,226 patients were randomized (age M= 58,2), 49% of them were woman, 69,7% were already using antihypertensive medications. SBP decreased by 4.42 [95% CI -5.56, -3.28] comparing intervention group vs usual care group, DBP by 1.63 [95% CI -2.44, -0.83]. Overall, 56% of patients achieved BP control in intervention group vs 44% in usual care group, OR= 1.87 [95% CI 1.51, 2.31]. Data on intervention direct costs was provided in two studies. Third study estimated differences in inpatient utilization, outpatient expenditures and total expenditures between intervention and usual care group. Conclusions: Overall, interventions were effective and achieved almost 5 mmHg decrease of SBP. This may have an impact on preventing cardiovascular disease, morbidity and mortality in hypertensive patients. Yet there is a lack of pharmacoeconomic evaluation on life style change interventions.