A new systematic review and network meta-analysis protocol aims to assess the effectiveness of non-pharmacological interventions for primary hypertension, addressing a critical gap in hypertension management where fewer than 30% of patients achieve blood pressure control with medication alone.
The protocol, published in BMJ Open, will examine randomized controlled trials conducted between January 2014 and August 2024, focusing on interventions including exercise, relaxation, acupuncture, diet, yoga, lifestyle modifications, meditation, breathing techniques, tai chi, and stress reduction.
"Primary hypertension affects over one billion individuals globally, yet less than 30% achieve controlled blood pressure with medication," the researchers note. "Many patients require a combination of multiple medications to reach targets, but adverse effects and financial burdens undermine adherence."
The study will utilize nine academic databases and three clinical trial registries to identify relevant trials. The primary outcomes will measure changes in systolic and diastolic blood pressure. The researchers will employ both pairwise and Bayesian network meta-analysis using R statistical software.
The protocol addresses a significant clinical challenge: prehypertension affects 25%-50% of adults, increasing their risk of cardiovascular complications. Early intervention through non-pharmacological approaches could potentially delay the need for medication.
Notable strengths of the protocol include its comprehensive evaluation of evidence from the past decade and detailed categorization of diverse non-pharmacological interventions. However, the researchers acknowledge that including a wide range of interventions may introduce heterogeneity and potential biases in data interpretation.
The study aims to provide evidence-based recommendations for integrating these interventions into community-based chronic disease management, particularly relevant given that approximately two-thirds of hypertensive patients reside in low-income and middle-income countries.
Results will be published in peer-reviewed journals upon completion. The protocol is registered under PROSPERO number CRD42023451073.