Non-pharmacological interventions for older patients with hypertension: A systematic review and network meta-analysis

Abstract

Objective: To determine the most effective non-pharmacological interventions to control the blood pressure variation in older hypertensive patients.

Methods: Primary endpoints were office systolic blood pressure (SBP) and diastolic blood pressure (DBP). The quality of evidence was assessed using the "risk of bias 2″ tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. We performed a Bayesian network meta-analysis using R-4.0.2 software to compare the efficacy of interventions.

Results: 36 eligible studies (3,531 patients) with a median follow-up of 12 weeks, assessing 18 non-pharmacological interventions, were included. The percentages of high, moderate, low, and very low certainty evidence were 16.7%, 38.9%, 33.3%, and 11.1%, respectively.

Conclusion: High certainty evidence suggests that self-management education is most effective in lowering SBP and DBP in older patients with hypertension, followed by moderate-intensity aerobic exercise. Moderate-intensity resistance training is the most effective exercise for lowering SBP.

Registration: PROSPERO, #CRD42020209850.

Keywords: Blood pressure; Hypertension; Network meta-analysis; Non-pharmacological interventions; Older patients; Systematic review.