TY - JOUR
T1 - Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients
T2 - A systematic review and meta-analysis
AU - Mills, Katherine T.
AU - Obst, Katherine M.
AU - Shen, Wei
AU - Molina, Sandra
AU - Zhang, Hui Jie
AU - He, Hua
AU - Cooper, Lisa A.
AU - He, Jiang
N1 - Funding Information:
By award P20GM109036 from the National Institute of General Medical Sciences and award U01HL114197 from the National Heart, Lung, and Blood Institute. Primary Funding Source: National Institutes of Health.
Funding Information:
Financial Support: By award P20GM109036 from the National Institute of General Medical Sciences and award U01HL114197 from the National Heart, Lung, and Blood Institute.
Funding Information:
This work was supported in part by the National Institute of General Medical Sciences and the National Heart, Lung, and Blood Institute. The funding sources had no role in the design, conduct, or reporting of the study or the decision to publish the manuscript.
Publisher Copyright:
© 2018 American College of Physicians.
PY - 2018/1/16
Y1 - 2018/1/16
N2 - Background: The prevalence of hypertension is high and is increasing worldwide, whereas the proportion of controlled hypertension is low. Purpose: To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. Data Sources: Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches. Study Selection: Randomized controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension. Data Extraction: Two investigators independently extracted data and assessed study quality. Data Synthesis: 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. Limitation: Sparse data from low- and middle-income countries; few trials of some implementation strategies, such as provider training; and possible publication bias. Conclusion: 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.
AB - Background: The prevalence of hypertension is high and is increasing worldwide, whereas the proportion of controlled hypertension is low. Purpose: To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. Data Sources: Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches. Study Selection: Randomized controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension. Data Extraction: Two investigators independently extracted data and assessed study quality. Data Synthesis: 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. Limitation: Sparse data from low- and middle-income countries; few trials of some implementation strategies, such as provider training; and possible publication bias. Conclusion: 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.
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U2 - 10.7326/M17-1805
DO - 10.7326/M17-1805
M3 - Review article
C2 - 29277852
AN - SCOPUS:85044430917
SN - 0003-4819
VL - 168
SP - 110
EP - 120
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 2
ER -