Non-pharmacological Management of Hypertension in Arab Countries: A Scoping Review

Abstract

Background: Non-pharmacological interventions, such as healthy dietary approaches and physical activity, have always been a crucial part of hypertension (HTN) control in clinical practice. These non-pharmacological interventions, however, have never been reviewed in the literature of Arab countries. This review has quantified and evaluated non-pharmacological interventional studies conducted in Arab countries until 2023. Methods: Medline, Web of Science, PubMed, the Cochrane Library, Embase, Science Direct, Scopus, ERIC, ProQuest, Springer, Google Scholar, and CINAHL were explored from database inception until September 2023. Articles of relevance were screened based on their titles and abstracts for selection criteria. Eligible studies were reviewed, and information was retrieved. Jadad scores and the Downs and Black checklist were used to evaluate randomized controlled trials (RCTs) and quasi-experimental studies, respectively. Results: A total of 12 RCTs and 5 quasi-experimental studies met the selection criteria. The studied interventions were eHealth applications, educational programs, wet cupping, physical exercise, adherence therapy, green tea, lifestyle interventions, dietary approaches to stop HTN, motivational interviewing, and cold hibiscus beverages. The most commonly used outcome measure was blood pressure. Nine studies scored high quality. The low and neutral quality scores were mainly due to loss of blindness, poor reporting of participants’ characteristics, loss of follow-up, and failure to account for potential confounders. Conclusion: There is a scarcity of HTN non-pharmacological interventional studies, aside from the low or modest quality of nearly 50% of them. Hence, it is recommended that further high-quality interventional studies focus on the areas of dietary approaches (especially DASH), exercise, theory-based education, and behavioral counseling in Arab countries.