Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis
Abstract
Hypertension is a major public health challenge because of its high prevalence and associated cardiovascular disease and premature death (1, 2). Randomized clinical trials have shown that pharmaceutical treatment and lifestyle modifications reduce blood pressure (BP) and risk for cardiovascular disease (3, 4). Despite the proven effectiveness of these interventions, only 13.8% of adults with hypertension and 37.1% of patients with treated hypertension worldwide had their BP controlled in 2010 (1). Barriers to hypertension control have been identified at the health care system, health care provider, and patient levels (5). Such barriers include limited health care resources, lack of performance standards, and limited reimbursement for health coaching at the system level; lack of adherence to clinical guidelines at the provider level; and lack of adherence to prescribed medications and lifestyle modifications at the patient level (5). Implementation strategies to overcome the barriers to BP control, such as home BP monitoring, health coaching, provider training, and team-based care, have been tested in randomized trials (6, 7). Most trials, however, have relatively small sample sizes and limited statistical power to reliably estimate intervention effects. Two previous reviews of implementation strategies for BP reduction included studies published up to 2003 and 2008 (6, 7). They showed that, compared with usual care, many implementation strategies, including team change and…
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