Effectiveness of culturally adapted lifestyle intervention package on blood pressure: A systematic review

Objectives: This systematic review aimed to identify culturally adapted lifestyle intervention packages and evaluate their effectiveness in reducing blood pressure across diverse populations. The focus was on interventions incorporating dietary, physical activity, and behavioral components within culturally relevant contexts. Study design: Systematic review of literature. Methods: A comprehensive systematic review search was conducted across PubMed, CINAHL, Scopus, Embase, and the Cochrane Library from March 5 to 11, 2024, covering studies published from 1995 to 2024, per the registered PROSPERO protocol. Search strategies targeted three key concepts: blood pressure, cultural adaptation, and lifestyle interventions, with cultural adaptation defined as any change made to the intervention's content, delivery, or materials to take into account the language, dietary patterns, social or societal norms, or community structures of the target group. Reference lists of included articles and relevant reviews were manually screened and explored. All studies were assessed using predefined inclusion and exclusion criteria to ensure methodological rigor and relevance. Results: Thirty-two studies involving 21,990 participants aged 18-95 years were included. Sample sizes ranged from 19 to 10,741, with most studies enrolling both sexes. Most interventions reported significant reductions in systolic and/or diastolic blood pressure. Multi-component interventions combining dietary modification, physical activity, and behavioral education were consistently effective. Culturally tailored programs, particularly group-based interventions with longer duration and follow-up, showed sustained improvements; certainty of evidence, assessed using GRADE, was moderate for dietary interventions but very low for behavioral/educational and exercise-based interventions, reflecting variation between studies and the predominance of data from high-income countries. Conclusions: Culturally adapted lifestyle interventions are effective, feasible, and sustainable strategies for lowering blood pressure. Multi-component approaches that integrate dietary, physical, and behavioral elements, particularly when culturally contextualized and community-based, offer practical, non-pharmacological options for hypertension management across diverse populations.