Effectiveness of multiple combined lifestyle interventions in reducing blood pressure among patients with prehypertension and hypertension: a network meta-analysis

Abstract Background Different combinations of lifestyle interventions have been studied with varying results on hypertension control. Hence, this review was done to compare multiple combined lifestyle intervention in reducing blood pressure (BP) among patients with prehypertension or hypertension. Methods We conducted systematic search in the following databases: MEDLINE, PubMed Central, CENTRAL, ScienceDirect, Google Scholar from 1964 until November 2020. Estimates of comparative intervention effect from network meta-analyses (random-effects model) were represented as mean difference (MD) with 95% confidence interval. Results In total, 14 studies with 2451 participants were included. Almost all the studies had high risk of bias. Healthy diet (HD) and physical activity (PA) combination showed highest mean reduction in systolic BP (−9.88 mmHg) and diastolic BP (−6.28 mmHg) followed by HD + PA + smoking cessation + alcohol restriction combination (systolic BP = −6.58 mmHg, diastolic BP = −4.09 mmHg) compared with usual care. HD and PA combination had the highest probability of being the best intervention (82.8% for SBP and 81.7% for DBP). Conclusion We found that HD and PA are the most important combination of lifestyle modifications for prehypertensive and hypertensive patients. Hence, a coordinated approach is required from the clinicians by integrating beneficial effect of these modifications through education, counselling and support. Summary Box What is already known on this topic? Various combinations of these multiple lifestyle interventions have been studied with varying results. Hence, it would be beneficial to find out the intervention combination with maximum effectiveness in controlling the blood pressure among prehypertensive or hypertensive patients. What is added by this report? We found that healthy diet and physical activity are the most important combination of lifestyle modifications required to achieve maximum reduction in SBP and DBP amongst HTN patients. What are the implications for public health practice? Our study has several implications for the clinicians and public health professionals. A coordinated approach is required from the clinicians by integrating the beneficial effect of these modifications through education, counselling and support. Public health professionals and policy makers should make use of these findings to design the policy, programme or scheme to tackle the burden of HTN or improve the control status amongst the established patients.