Key result
Community-based interventions for hypertension care in China significantly reduced systolic blood pressure by an average of 13.73 mm Hg compared to control.
Why the study?
Do community interventions reduce blood pressure in patients with hypertension in China?
Meta-Analysis (n=21,942)
Unclear (only 5 studies explicitly used blinding)
Randomized or quasi-randomized
Do community interventions reduce blood pressure in patients with hypertension in China?
Community-based interventions for hypertension in China significantly reduce systolic and diastolic blood pressure, though current evidence is limited by poor study quality and high heterogeneity.
Answers are grounded in this paper and cite their sources.
Community interventions lower BP ~7/4 mmHg in Chinese patients; extends evidence for primary care models in LMICs but needs rigorous trials.
BACKGROUND: Hypertension is a serious public health problem in China and in other developing countries. Our aim is to conduct a systematic review of studies on the effectiveness of community interventions for hypertension management in China. METHODS: China National Knowledge Infrastructure, PubMed, and references of retrieved articles were searched to identify randomised or quasi-randomised controlled studies that evaluated community hypertension care in mainland China. One reviewer extracted and a second reviewer checked data from the included studies. RESULTS: We included 94 studies, 93 of which were in Chinese language, that evaluated the following interventions: health education, improved monitoring, family-support, self-management, healthcare management changes and training of providers. The study quality was generally poor, with high risk of biased outcome reporting and significant heterogeneity between studies. When reported, the vast majority of the included studies reported statistically significantly improved outcomes in the intervention group. By assuming zero treatment effects for missing outcomes, the weighted reduction in the intervention group was 6.9 (95% CI: 4.9 to 8.9) mm Hg for systolic BP, and 3.8 (95% CI: 2.6 to 5.0) mm Hg for diastolic BP. Exploratory subgroup analyses found no significant differences between different interventions. CONCLUSIONS: After taking account of possible reporting biases, a wide range of community interventions for hypertension care remain effective. The findings have implications for China and other low and middle income countries facing similar challenges. Because of significant heterogeneity and high risk of bias in the available studies, further well designed studies should be conducted in China to provide high quality evidence to inform policy decisions on hypertension control.
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Lu et al. (2012) conducted a meta-analysis in Hypertension (n=21,942). Community-based interventions (health education, monitoring, family support, self-management, organizational changes, provider training) vs. Control (usual care or no intervention) was evaluated on Difference in systolic blood pressure between groups (MD 13.73 mm Hg, 95% CI 11.53 to 15.93). Community-based interventions for hypertension care in China significantly reduced systolic blood pressure by an average of 13.73 mm Hg compared to control.
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