Heart Disease and Stroke Prevention: Interactive Digital Interventions for Blood Pressure Self-Management

The Community Preventive Services Task Force (CPSTF) uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention.

McLean G, Band R, Saunderson K, Hanlon P, Murray E, et al. Digital interventions to promote self-management in adults with hypertension: systematic review and meta-analysis. Journal of Hypertension 2016;34(4):600-12.

The review included seven randomized controlled trials (search period through 2014). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included seven studies.

• Among recruited patients who had high blood pressure, interventions led to the following outcomes:
  
  • Systolic blood pressure decreased by a mean of 3.7 mmHg (6 studies)
  • Diastolic blood pressure decreased by a mean of 2.4 mmHg (5 studies)
  • One study reported patients in the intervention group were significantly more likely to have their blood pressure under control after 24 months.

A systematic review of economic evidence has not been conducted.

While additional research is warranted, the CPSTF finding should be applicable to the use of interactive digital interventions in U.S. healthcare settings for adults who have high blood pressure.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• Are interventions effective in helping patients control their blood pressure over longer periods of time (1-2 years)?
• Are these interventions effective in reducing morbidity, mortality, and health care utilization associated with hypertension?
• What factors influence intervention effectiveness?
  
  • Use with or without self-measured blood pressure monitoring?
  • Use with or without additional counseling or interpersonal contact?
  • Setting (i.e. workplaces or community)?
  • Patients’ race, ethnicity, or socioeconomic status?
  • Length of time since hypertension diagnosis?
  • Level of blood pressure control at enrollment?
  • Use with novel or existing smartphone applications?

• All of the included studies were randomized controlled trials.
• Studies were conducted in the United States (3 studies), Canada (1 study), Finland (1 study), Korea (1 study), and Honduras and Mexico (1).
• Patients were recruited in healthcare settings (6 studies) and workplaces (1 study).
• Two U.S. studies included clinics that served urban, low-income communities. In one of these studies, recruited patients were primarily African-American (72%) or Hispanic (14%).
• Evaluated interventions were of short duration (median 6 months).
• Interventions used mobile phones (3 studies), web-based programs (3 studies), or telephones (1 study).
• While limited information was provided about the digital content, all of the interventions included health education related to blood pressure self-management.
• Patients interacted with digital components daily (3 studies) or weekly (3 studies); interactions were variable in the remaining study.
• In five of the studies, digital components were part of self-measured blood pressure monitoring (SMBP) interventions.
• Three studies offered contact or appropriate follow-up with a health professional or community health worker.