Key result
Clinician-oriented interventions for hypertension management in primary care were less effective than usual care, with the control group achieving a 2.12 mmHg greater reduction in systolic blood pressure.
Why the study?
Hypertension management remains challenging with varying primary care quality, prompting examination of clinician-oriented strategies like digital tools to improve antihypertensive prescribing and blood pressure control for secondary prevention.
Do clinician-oriented strategies improve blood pressure control in hypertensive patients with secondary complications in primary care settings compared to usual care?
Meta-Analysis (n=6,491)
Do clinician-oriented strategies improve blood pressure control in hypertensive patients with secondary complications in primary care settings compared to usual care?
Effect estimate: MD 2.12 mmHg (95% CI 0.98; 3.26)
p-value: p=0.0003
Clinician-oriented interventions in primary care were unexpectedly less effective than usual care at lowering systolic blood pressure in hypertensive patients with secondary complications.
Avoid clinician-oriented interventions over usual care for primary care hypertension; challenges assumptions of benefit in patients with secondary complications.
Despite significant pharmacological advancements, hypertension management remains challenging, with varying quality of primary care. Digital tools and other non-pharmacological interventions hold promise in addressing this challenge. Consequently, a thorough examination of these interventions is recommended. This meta-analysis focuses on clinician-oriented strategies aimed at improving hypertension management, to assess the most effective approaches for improving antihypertensive prescribing and blood pressure control for secondary prevention. This was done through a systematic review of randomized controlled trials published in PubMed and Embase since the beginning of 2010 that aimed to enhance antihypertensive medication prescription in primary care settings for hypertensive patients with secondary complications while reporting changes in blood pressure or target achievement. We screened 6305 records. Four studies met the inclusion criteria, with reported interventions including physician education and the implementation of electronic decision support systems. All studies showed that the control group had a statistically significant lower systolic blood pressure, but the effect on diastolic blood pressure was not statistically significant. The overall mean difference was 2.12 mmHg (95% CI = 0.98; 3.26, P-value = 0.0003) for systolic blood pressure in favor of the control group and 1.22 mmHg (95% CI = -0.48; 3.26, P-value = 0.16) for diastolic blood pressure, which was not statistically significant. Despite considerable efforts to control hypertension, it remains a significant obstacle to optimal cardiovascular risk reduction. This review is also limited by a scarcity of studies.
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Althuwaikh et al. (2023) conducted a meta-analysis in Hypertension with secondary complications (n=6,491). Clinician-oriented strategies (physician education and electronic decision support systems) vs. Usual care was evaluated on Systolic blood pressure (MD 2.12 mmHg, 95% CI 0.98; 3.26, p=0.0003). Clinician-oriented interventions for hypertension management in primary care were less effective than usual care, with the control group achieving a 2.12 mmHg greater reduction in systolic blood pressure.
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