Group-delivered interventions to improve control of blood pressure in hypertension

Problem

High blood pressure (hypertension) is the most common chronic condition presented in primary care and is the leading, global cause of cardiovascular disease and events. Interventions to improve the control of blood pressure and subsequent cardiovascular risk are therefore important. We have found, in a large ongoing systematic review, that pharmacist- and nurse-led interventions improve hypertension management, particularly if clinicians are able to recommend or prescribe changes in medication, deliver face to face consultations and undertake monthly follow-up until blood pressure targets are achieved. Individual patient interventions are time-consuming for the clinician and therefore group interventions may be a more efficient, and cost-effective, way to improve hypertension management. However, evidence from previous studies of group-based hypertension interventions is equivocal and therefore there is a need to summarise the current literature before recommending any changes to clinical practice.AimTo determine if group-based hypertension interventions can achieve improved outcomes for hypertensive individuals compared to usual care or no intervention.

Approach

Systematic review, meta-analysis and narrative synthesis, where appropriate. We searched MEDLINE, Embase, CENTRAL and CINAHL to 30th August 2019 for randomised controlled trials comparing group-based interventions for adults (> 18 years) with treated or untreated hypertension, with either no intervention or usual care in primary, outpatient or community care settings. Data on type of group intervention (e.g. dietary, educational, lifestyle or medicine optimisation), definition of hypertension, blood pressure measurement method, change in systolic or diastolic blood pressure and attainment of targets, cost of interventions and study level demographics will be extracted to a standard proforma by two reviewers. Pooled estimates of changes in blood pressure will be calculated and compared between types of interventions, care setting and disease subgroups using meta-analyses in random effects models and narratively synthesised where applicable. Statistical heterogeneity of pooled blood pressure changes will be quantified using I2 statistics and explored using sensitivity analyses and meta-regression of study level variables. Study quality will be judged using the Cochrane Risk of Bias (RoB2) tool and publication bias will be assessed using funnel plots and quantified using Egger’s tests.

Findings

After duplicates were removed, 3746 unique citations reporting group hypertension interventions were screened and 228 full texts are currently being reviewed. Results from this ongoing systematic review and meta-analysis will be presented at the conference. This study is registered with PROSPERO: CRD42019145126.

Consequences

We anticipate that our results will inform future strategies and guidelines to enable a more efficient and cost-effective approach to managing hypertension in primary, community and outpatient care settings.