The effectiveness of electronic health interventions on blood pressure control, self-care behavioural outcomes and psychosocial well-being in patients with hypertension: A systematic review and meta-analysis

Abstract

Objectives: Hypertension is a global health issue. Electronic health (eHealth) is a potential alternative for managing hypertension and modifying hypertension-related self-care set of behaviour. This review aims to identify the delivery mode and strategies used by current eHealth interventions and examine the effectiveness of eHealth on blood pressure control, self-care behavioural outcomes and psychosocial well-being.

Design: Systematic review and meta-analysis.

Data source: Ten English databases (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Joanna Briggs Institute EBP Database, MEDLINE, CINAHL Plus, PsycINFO, SCOPUS, Web of Science and INSPEC) and two Chinese databases (China Journal Net and WanFang Data) were searched from January 2000 to November 2017.

Review methods: This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Two reviewers independently selected potential articles and extracted the details of each eligible article. The Randomized Controlled Trial Checklist of Joanna Briggs Institute was used to assess the methodological quality of the included articles. Meta-analysis was conducted using Review Manager 5.3 for at least two studies reporting the same outcome. Otherwise, narrative synthesis was performed.

Results: Fifteen articles from fourteen studies satisfied the inclusion criteria. The pooled result of 13 studies reported that eHealth intervention significantly affected the reduction of systolic blood pressure (mean difference [MD]: -5.96 mmHg, 95% confidence interval [CI]: -9.21 to -2.70, p < .001) and diastolic blood pressure (MD: -3.35 mmHg, 95% CI: -6.36 to -0.35, p < .05). eHealth interventions significantly decreased the proportion of patients with inadequate blood pressure control (risk ratio: 0.69, 95% CI: 0.57-0.84, p < .001) and their body weight (MD: -1.08 kg, 95% CI: -2.04 to -0.13, p < .05). Regarding self-care behavioural outcomes, the pooled results show that eHealth interventions significantly reduced the sodium intake.

Conclusions: This study reported that eHealth interventions positively affect blood pressure control and thus could be a promising alternative in the management of hypertension. However, their effectiveness on self-care behavioural change and psychosocial well-being is insufficient. Therefore, additional eHealth interventions with rigorous experimental design on hypertension self-care are needed to provide a robust evidence for a wide population and to address the increasing health care needs of patients with hypertension.

Keywords: Blood pressure control; Electronic health; Hypertension; Lifestyle; Self-care.