A systematic review and meta-analysis of the effect of mobile health (mHealth) interventions vs. usual care on self-management, medication adherence, and blood pressure in adults with primary hypertension

Background: Hypertension is a leading global public health challenge. While mobile health (mHealth) interventions have emerged as promising tools, existing studies have produced inconsistent findings regarding their efficacy on specific domains of self-management and long-term blood pressure (BP) control. This systematic review and meta-analysis aims to evaluate the impact of mHealth interventions compared with usual care on self-management ability, medication adherence, and BP control in adults with primary hypertension. Methods: We searched PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases from January 1, 2015, to December 31, 2023. Eligible studies were randomized controlled trials (RCTs) comparing mHealth interventions [e.g., applications (Apps), short message service (SMS), WeChat] with usual care in adults with primary hypertension. Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias tool. Primary outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and standardized self-management/adherence scores. Data were pooled using random-effects models. Results: A total of 15 RCTs encompassing 4,286 participants were included. The interventions ranged from unidirectional SMS reminders to interactive Apps with clinician feedback, with follow-up durations from 3 to 12 months. Compared with usual care, mHealth interventions reduced SBP [weighted mean difference (WMD) =−4.45 mmHg, 95% confidence interval (CI): −5.82 to −3.08; P<0.001] and DBP (WMD =−2.47 mmHg, 95% CI: −3.51 to −1.43; P<0.001). Furthermore, mHealth interventions improved overall self-management scores [standardized mean difference (SMD) =0.68, 95% CI: 0.45 to 0.91; P<0.001] and medication adherence (SMD =0.55, 95% CI: 0.32 to 0.78; P<0.001). The overall quality of evidence ranged from moderate to low due to high heterogeneity and risk of performance bias. Conclusions: mHealth interventions may improve self-management abilities and lower BP in hypertensive patients. However, given the substantial clinical heterogeneity of the included interventions and potential risk of bias, these pooled results should be interpreted cautiously and may not apply equally to all mHealth approaches.