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Wildenauer A, Maurer LF, Rötzer L, Eggert T, Schöbel C. The effects of a digital lifestyle intervention in patients with hypertension: Results of a pilot randomized controlled trial. J Clin Hypertens (Greenwich) 2024; 26:902-911. [PMID: 38992970 PMCID: PMC11301437 DOI: 10.1111/jch.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 07/13/2024]
Abstract
In this pilot study, the authors investigated the preliminary effectiveness of the digital lifestyle intervention, actensio (mementor DE GmbH), in treating arterial hypertension. Adults with arterial hypertension were randomly assigned to an intervention group (actensio + standard care) or a control group (waiting list + standard care) in a 1:1 ratio. Primary and secondary endpoints were assessed at baseline (t0) and 3 months post-randomization (t1). The primary endpoint was average systolic blood pressure, measured at home for 1 week. Secondary endpoints included patient engagement (measured using the "patient activation measure"; PAM-13), average diastolic blood pressure, and heart rate. All endpoints were analyzed using ANCOVA models, following an intention-to-treat approach, while adjusting for baseline values. Missing data were estimated using multiple imputation models. A total of N = 102 participants (f = 59, age = 52.94 ± 9.01) were randomized to either the intervention (IG; N = 52) or the control group (CG; N = 50), of which N = 80 completed the blood pressure diary, and N = 81 the PAM-13 at t1. Between-group comparisons showed an average group difference in systolic blood pressure of -5.06 mm Hg (95% CI = -8.71 to -1.41, p = .013) between the intervention group (M = 137.37 ± 10.13) and the control group (M = 142.35 ± 11.23). Average group difference for patient engagement was 3.35 points with a trend towards statistical significance (95% CI = -018 to 6.89, p = .064), favoring the intervention group (MIG = 79.38 ± 9.44 vs. MCG = 75.45 ± 10.62). There were no group differences in diastolic blood pressure (-1.78 mm Hg; 95% CI = -4.50 to 0.95, p = .402) and heart rate (-0.684; 95% CI = -3.73 to 2.36, p = 0.683). The results of the present pilot study confirm the preliminary effectiveness of the digital lifestyle intervention, actensio, in reducing high blood pressure in patients with hypertension.
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Chan RJ, Parikh N, Ahmed S, Ruzicka M, Hiremath S. Blood Pressure Control Should Focus on More Potassium: Controversies in Hypertension. Hypertension 2024; 81:501-509. [PMID: 37641923 DOI: 10.1161/hypertensionaha.123.20545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Ryan J Chan
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Namrata Parikh
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Sumaiya Ahmed
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
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Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, Sharman JE, Vogt L, Burrell LM, Korostovtseva L, Zec M, Patil M, Schultz MG, Wallen MP, Renna NF, Islam SMS, Hiremath S, Gyeltshen T, Chia YC, Gupta A, Schutte AE, Klein B, Borghi C, Browning CJ, Czesnikiewicz-Guzik M, Lee HY, Itoh H, Miura K, Brunström M, Campbell NR, Akinnibossun OA, Veerabhadrappa P, Wainford RD, Kruger R, Thomas SA, Komori T, Ralapanawa U, Cornelissen VA, Kapil V, Li Y, Zhang Y, Jafar TH, Khan N, Williams B, Stergiou G, Tomaszewski M. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens 2024; 42:23-49. [PMID: 37712135 PMCID: PMC10713007 DOI: 10.1097/hjh.0000000000003563] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.
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Affiliation(s)
- Fadi J. Charchar
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
- Department of Physiology, University of Melbourne, Melbourne, Australia
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Priscilla R. Prestes
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Charlotte Mills
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Francine Z. Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
| | - Lyudmila Korostovtseva
- Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia
| | - Manja Zec
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
- Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad
- Hypertension and Nutrition, Core Group of IAPEN India, India
| | - Martin G. Schultz
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | | | - Nicolás F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada
| | - Tshewang Gyeltshen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abhinav Gupta
- Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy
| | - Colette J. Browning
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Marta Czesnikiewicz-Guzik
- School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK
- Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hiroshi Itoh
- Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Norm R.C. Campbell
- Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Praveen Veerabhadrappa
- Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania
| | - Richard D. Wainford
- Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston
- Division of Cardiology, Emory University, Atlanta, USA
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Shane A. Thomas
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Bryan Williams
- University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester
- Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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Nyarambi D, Osedeme F, Mamudu HM, Littleton MA, Poole AM, Blair C, Voigt C, Gregory R, Drozek D, Stewart DW, Weierbach FM, Paul TK, Flores EK, Wei H. Setting Patient-Centered Priorities for Cardiovascular Disease in Central Appalachia: Engaging Stakeholder Experts to Develop a Research Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095660. [PMID: 37174178 PMCID: PMC10178300 DOI: 10.3390/ijerph20095660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continues to exist in the Central Appalachian Region (CAR) of the United States. Previous studies to gather data about patient-centered care for CVD in the region were conducted through focus group discussions. There have not been any studies that used a collaborative framework where patients, providers, and community stakeholders were engaged as panelists. The objective of this study was to identify patient-centered research priorities for CVD in the CAR. We used a modified Delphi approach to administer questionnaires to forty-two stakeholder experts in six states representing the CAR between the fall of 2018 and the summer of 2019. Their responses were analyzed for rankings and derived priorities by research gaps. Six of the fifteen research priorities identified were patient-centered. These patient-centered priorities included shorter wait times for appointments; educating patients at their level; empowering patients to take responsibility for their health; access to quality providers; heart disease specialists for rural areas; and lifestyle changes. The participants' commitments to identify patient-centered research priorities indicate the potential to engage in community-based collaboration to address the burden of CVD in the CAR.
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Affiliation(s)
- Dumisa Nyarambi
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Fenose Osedeme
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
| | - Mary A Littleton
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Amy M Poole
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
| | - Cynthia Blair
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
| | - Carl Voigt
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
| | - Rob Gregory
- Karing Hearts Cardiology, Johnson City, TN 37604, USA
| | - David Drozek
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - David W Stewart
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Florence M Weierbach
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
- College of Nursing, East Tennessee State University, Johnson City, TN 37614, USA
| | - Timir K Paul
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
- College of Medicine, Health Science Center, University of Tennessee-Nashville, Nashville, TN 37203, USA
| | - Emily K Flores
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Holly Wei
- College of Nursing, East Tennessee State University, Johnson City, TN 37614, USA
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5
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Leitch S, Logan M, Beishon L, Quinn TJ. International research priority setting exercises in stroke: A systematic review. Int J Stroke 2023; 18:133-143. [PMID: 35422174 DOI: 10.1177/17474930221096935] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Agreeing on priority topics for stroke research can help make best use of limited funding, people, and time. Formal priority-setting exercises collate stakeholders' opinions to reach consensus on the most important research questions. Several stroke research priority setting exercises have been published. Exploring commonalities and differences between these exercises could bring a better understanding of priority research topics. AIM We collated and compared published stroke research priority setting exercises across international healthcare systems. SUMMARY OF REVIEW Multidisciplinary, electronic literature databases were searched from 2000 to 2021, using a validated search syntax. Inclusion criteria were: full article; stroke focus (any subtype); prioritization method described; and lists priorities for research. Priorities were extracted, coded, and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice and the Reporting guideline for priority setting of health research checklists were used to assess methodological and reporting quality respectively. From 623 titles assessed, 14 studies were eligible for inclusion, including 2410 participants and describing 165 priorities. The majority of priority setting exercises were conducted in high-income countries (86%, n = 12 articles), published between 2011 and 2021 (64%, n = 9), and included views of healthcare professionals (57%, n = 8), and stroke survivors (50%, n = 7). Caregivers (n = 3, 21%) were under-represented. The James Lind Alliance priority setting method was most commonly used (50%, n = 7). Priorities were grouped into 10 thematic categories. Rehabilitation and follow-up was the most common priority theme (15%, n = 25 priorities), followed by psychological recovery (14%, n = 23), pathology (14%, n = 23), and caregivers and support (14%, n = 23). Priorities differed by year and case-mix (stakeholder group and demographics) of respondents. No article was judged high quality for all aspects of method or reporting. Common limitations were around inclusiveness and evaluation of the exercise. CONCLUSION Stroke research priorities are dynamic and context-specific. However, there was a common theme of prioritizing research that considered life after stroke. Future priority settings should consider the inclusion of nonindustrialized countries and stroke survivors with a range of impairments.
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Affiliation(s)
- Stephanie Leitch
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Monica Logan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Ho A, Webster L, Bowen L, Creighton F, Findlay S, Gale C, Green M, Gronlund T, Magee LA, McManus RJ, Mistry HD, Singleton G, Thornton J, Whybrow R, Chappell L. Research priorities for pregnancy hypertension: a UK priority setting partnership with the James Lind Alliance. BMJ Open 2020; 10:e036347. [PMID: 32665388 PMCID: PMC7365422 DOI: 10.1136/bmjopen-2019-036347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify research priorities for hypertensive disorders of pregnancy from individuals with lived experience and healthcare professionals. DESIGN Prospective surveys and consensus meetings using principles outlined by the James Lind Alliance. SETTING UK. METHODS A steering group was established and 'uncertainties' were gathered using an online survey and literature search. An interim online survey ranked long-listed questions and the top 10 research questions were reached by consensus at a final prioritisation workshop. PARTICIPANTS Women, partners, relatives and friends of those with lived experience of pregnancy hypertension, researchers and healthcare professionals. RESULTS The initial online survey was answered by 278 participants (180 women with lived experience, 9 partners/relatives/friends, 71 healthcare professionals and 18 researchers). Together with a literature search, this identified 764 questions which were refined into 50 summary questions. All summary questions were presented in an interim prioritisation survey that was answered by 155 participants (87 women with lived experience, 4 partners/relatives/friends, 49 healthcare professionals and 15 researchers). The top 25 highest ranked questions were considered by the final prioritisation workshop. The top 10 uncertainties were identified by consensus and ranked as follows in order of priority: long-term consequences of pregnancy hypertension (for the woman and baby), short-term complications of pregnancy hypertension (for the woman and baby), screening tests for pre-eclampsia, prevention of long-term problems (for the woman and baby), causes of pregnancy hypertension, prevention of recurrent pregnancy hypertension, educational needs of healthcare professionals, diagnosis of pre-eclampsia, management of pregnancy hypertension, provision of support for women and families. CONCLUSIONS Research priorities shared by those with lived experience of pregnancy hypertension and healthcare professionals have been identified. Researchers should use these to inform the choice of future studies in this area.
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Affiliation(s)
- Alison Ho
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Louise Webster
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Liza Bowen
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | | | | | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, UK
| | - Toto Gronlund
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | - Laura A Magee
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Richard J McManus
- Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hiten D Mistry
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Jim Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rebecca Whybrow
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Lucy Chappell
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Levelink M, Voigt-Barbarowicz M, Brütt AL. Priorities of patients, caregivers and health-care professionals for health research - A systematic review. Health Expect 2020; 23:992-1006. [PMID: 32643854 PMCID: PMC7696132 DOI: 10.1111/hex.13090] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background Based on subjective experience, patients can identify research priorities important for health services research. A systematic method for priority setting has been developed by the James Lind Alliance. Objective This article reviews the literature on the research priorities of patients, caregivers and health‐care professionals and presents the prioritized research themes and prioritization methods used. Search strategy Three electronic databases were searched on 22 May 2018. The search was not limited to any time period or language. Inclusion criteria The included studies reported the identification and prioritization of research priorities involving patients, relatives and caregivers. Each included paper addressed a specific ICD‐coded health problem, and at least one‐third of the sample involved in the prioritization process was affected by the health problem. Data extraction and synthesis The 10 top‐ranked research priorities were included in the thematic analysis. With an inductive approach, a system of identified themes and subthemes was developed from the research priorities. Each research priority was assigned to one research theme. Main results The priority lists of 34 publications involving 331 research priorities were included. Nine main themes represent the content of the research priorities. The most frequently represented main themes are ‘Treatment’, ‘Patients’ and ‘Health condition’. The distribution of the research priorities varied depending on the health conditions and prioritization methods. Discussion and conclusions This review provides a comprehensive overview of the overarching research themes in research priorities of affected individuals. The results can guide future patient‐oriented research.
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Affiliation(s)
- Michael Levelink
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Mona Voigt-Barbarowicz
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Klaprat NMD, Askin N, MacIntosh A, Brunton N, Hay JL, Yardley JE, Marks SD, Sibley KM, Duhamel TA, McGavock JM. Filling gaps in type 1 diabetes and exercise research: a scoping review and priority-setting project. BMJ Open Diabetes Res Care 2020; 8:e001023. [PMID: 32139601 PMCID: PMC7059416 DOI: 10.1136/bmjdrc-2019-001023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/19/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Our team examined the characteristics of patient engagement (PE) practices in exercise-based randomized trials in type 1 diabetes (T1D), and facilitated T1D stakeholders in determining the top 10 list of priorities for exercise research. Two methodological approaches were employed: a scoping review and a modified James Lind Alliance priority-setting partnership. Published (Medline, Embase, CINAHL and Central databases) and grey literature (www.clinicaltrials.gov) were searched to identify randomized controlled trials of exercise interventions lasting minimum 4 weeks and available in English. We extracted information on PE and patient-reported outcomes (PROs) to identify if patient perspectives had been implemented. Based on results, we set out to determine exercise research priorities as a first step towards a patient-engaged research agenda. An online survey was distributed across Canada to collect research questions from patients, caregivers and healthcare providers. We qualitatively analyzed submitted questions and compiled a long list that a 12-person stakeholder steering committee used to identify the top 10 priority research questions. Of 9962 identified sources, 19 published trials and 4 trial registrations fulfilled inclusion criteria. No evidence of PE existed in any included study. Most commonly measured PROs were frequency of hypoglycemia (n=7) and quality of life (n=4). The priority-setting survey yielded 194 submitted research questions. Steering committee rankings identified 10 priorities focused on lifestyle factors and exercise modifications to maintain short-term glycemic control. Recent exercise-based randomized trials in T1D have not included PE and PROs. Patient priorities for exercise research have yet to be addressed with adequately designed clinical trials.
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Affiliation(s)
- Nika M D Klaprat
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea MacIntosh
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline L Hay
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Albrechtsen Research Centre, St Boniface Hospital Research, Winnipeg, Manitoba, Canada
| | - Jane E Yardley
- Faculty of Kinesiology, Sport and Recreation, University of Alberta-Augustana Campus, Camrose, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Seth D Marks
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Education Resource for Children and Adolescents, Winnipeg, Manitoba, Canada
| | - Kathryn M Sibley
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Albrechtsen Research Centre, St Boniface Hospital Research, Winnipeg, Manitoba, Canada
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan M McGavock
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada
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9
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Santana MJ, Zelinsky S, Ahmed S, Doktorchik C, James M, Wilton S, Quan H, Fernandez N, Anderson T, Butalia S. Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research. BMJ Open 2020; 10:e031187. [PMID: 32034018 PMCID: PMC7044837 DOI: 10.1136/bmjopen-2019-031187] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/09/2019] [Accepted: 01/14/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The overall goal of this study is to identify priorities for cardiovascular (CV) health research that are important to patients and clinician-researchers. We brought together a group of CV patients and clinician-researchers new to patient-oriented research (POR), to build a multidisciplinary POR team and form an advisory committee for the Libin Cardiovascular Institute of Alberta. DESIGN This qualitative POR used a participatory health research paradigm to work with participants in eliciting their priorities. Therefore, participants were involved in priority setting, and analysis of findings. Participants also developed a plan for continued engagement to support POR in CV health research. SETTING Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Canada. PARTICIPANTS A total of 23 participants, including patients and family caregivers (n=12) and clinician-researchers (n=11). RESULTS Participants identified barriers and facilitators to POR in CV health (lack of awareness of POR and poor understanding on the role of patients) and 10 research priorities for improving CV health. The CV health research priorities include: (1) CV disease prediction and prevention, (2) access to CV care, (3) communication with providers, (4) use of eHealth technology, (5) patient experiences in healthcare, (6) patient engagement, (7) transitions and continuity of CV care, (8) integrated CV care, (9) development of structures for patient-to-patient support and (10) research on rare heart diseases. CONCLUSIONS In this study, research priorities were identified by patients and clinician-researchers working together to improve CV health. Future research programme and projects will be developed to address these priorities. A key output of this study is the creation of the patient advisory council that will provide support and will work with clinician-researchers to improve CV health.
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Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sandra Zelinsky
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sadia Ahmed
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Chelsea Doktorchik
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Matthew James
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen Wilton
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Medicine, University of Calgary, Calgary, AB, Canada
- Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Medicine, University of Calgary, Calgary, AB, Canada
| | - Nicolas Fernandez
- Family and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Todd Anderson
- Medicine, University of Calgary, Calgary, AB, Canada
- Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Sonia Butalia
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Medicine, University of Calgary, Calgary, AB, Canada
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10
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Noone C, Leahy J, Morrissey EC, Newell J, Newell M, Dwyer CP, Murphy J, Doyle F, Murphy AW, Molloy GJ. Comparative efficacy of exercise and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: A network meta-analysis. Eur J Prev Cardiol 2019; 27:247-255. [DOI: 10.1177/2047487319879786] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims This analysis aims to estimate the comparative efficacy of anti-hypertensive medications and exercise interventions on systolic and diastolic blood pressure reduction in people with hypertension. Methods A systematic review was conducted focusing on randomised controlled trials (RCTs) of exercise interventions and first-line anti-hypertensives where blood pressure reduction was the primary outcome in those with hypertension. Network meta-analyses were conducted to generate estimates of comparative efficacy. Results We identified 93 RCTs ( N = 32,404, mean age in RCTs: 39–70 years) which compared placebo or usual care with first-line antihypertensives including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics and exercise interventions including aerobic training and dynamic resistance training. Of these, there were 81 (87%) trials related to medications ( n = 31,347, 97%) and 12 (13%) trials related to exercise ( n = 1057, 3%). The point estimates suggested that antihypertensive medications were more effective than exercise but there was insufficient evidence to suggest that first-line medications significantly reduced blood pressure to a greater extent than did the exercise interventions. Of the first-line treatments, angiotensin receptor blockers and calcium channel blockers had the highest treatment ranking, while exercise had the second lowest treatment ranking, followed by control conditions. Conclusion The current evidence base with a bias towards medication research may partly explain the circumspection around the efficacy of exercise in guidelines and practice. Clinicians may justifiably consider exercise for low risk hypertension patients who confirm a preference for such an approach.
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Affiliation(s)
- Chris Noone
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Joy Leahy
- The National Centre for Pharmacoeconomics, Saint James's Hospital, Dublin, Ireland
| | | | - John Newell
- School of Mathematics, Statistics, and Applied Mathematics, National University of Ireland Galway, Ireland
| | - Micheál Newell
- School of Medicine, National University of Ireland Galway, Ireland
| | | | - Jane Murphy
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
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11
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Nygaard A, Halvorsrud L, Linnerud S, Grov EK, Bergland A. The James Lind Alliance process approach: scoping review. BMJ Open 2019; 9:e027473. [PMID: 31473612 PMCID: PMC6720333 DOI: 10.1136/bmjopen-2018-027473] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To summarise study descriptions of the James Lind Alliance (JLA) approach to the priority setting partnership (PSP) process and how this process is used to identify uncertainties and to develop lists of top 10 priorities. DESIGN Scoping review. DATA SOURCES The Embase, Medline (Ovid), PubMed, CINAHL and the Cochrane Library as of October 2018. STUDY SELECTION All studies reporting the use of JLA process steps and the development of a list of top 10 priorities, with adult participants aged 18 years. DATA EXTRACTION A data extraction sheet was created to collect demographic details, study aims, sample and patient group details, PSP details (eg, stakeholders), lists of top 10 priorities, descriptions of JLA facilitator roles and the PSP stages followed. Individual and comparative appraisals were discussed among the scoping review authors until agreement was reached. RESULTS Database searches yielded 431 potentially relevant studies published in 2010-2018, of which 37 met the inclusion criteria. JLA process participants were patients, carers and clinicians, aged 18 years, who had experience with the study-relevant diagnoses. All studies reported having a steering group, although partners and stakeholders were described differently across studies. The number of JLA PSP process steps varied from four to eight. Uncertainties were typically collected via an online survey hosted on, or linked to, the PSP website. The number of submitted uncertainties varied across studies, from 323 submitted by 58 participants to 8227 submitted by 2587 participants. CONCLUSIONS JLA-based PSP makes a useful contribution to identifying research questions. Through this process, patients, carers and clinicians work together to identify and prioritise unanswered uncertainties. However, representation of those with different health conditions depends on their having the capacity and resources to participate. No studies reported difficulties in developing their top 10 priorities.
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Affiliation(s)
- Agnete Nygaard
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Center for Development of Institutional and Home Care, Lørenskog, Akershus
| | - Liv Halvorsrud
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Siv Linnerud
- Center for Development of Institutional and Home Care, Lørenskog, Akershus
| | - Ellen Karine Grov
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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12
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The History of Hypertension Guidelines in Canada. Can J Cardiol 2019; 35:582-589. [DOI: 10.1016/j.cjca.2019.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/23/2022] Open
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13
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Ma Y, Cheng HY, Cheng L, Sit JWH. The effectiveness of electronic health interventions on blood pressure control, self-care behavioural outcomes and psychosocial well-being in patients with hypertension: A systematic review and meta-analysis. Int J Nurs Stud 2018; 92:27-46. [PMID: 30690164 DOI: 10.1016/j.ijnurstu.2018.11.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/28/2018] [Accepted: 11/03/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Hypertension is a global health issue. Electronic health (eHealth) is a potential alternative for managing hypertension and modifying hypertension-related self-care set of behaviour. This review aims to identify the delivery mode and strategies used by current eHealth interventions and examine the effectiveness of eHealth on blood pressure control, self-care behavioural outcomes and psychosocial well-being. DESIGN Systematic review and meta-analysis. DATA SOURCE Ten English databases (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Joanna Briggs Institute EBP Database, MEDLINE, CINAHL Plus, PsycINFO, SCOPUS, Web of Science and INSPEC) and two Chinese databases (China Journal Net and WanFang Data) were searched from January 2000 to November 2017. REVIEW METHODS This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Two reviewers independently selected potential articles and extracted the details of each eligible article. The Randomized Controlled Trial Checklist of Joanna Briggs Institute was used to assess the methodological quality of the included articles. Meta-analysis was conducted using Review Manager 5.3 for at least two studies reporting the same outcome. Otherwise, narrative synthesis was performed. RESULTS Fifteen articles from fourteen studies satisfied the inclusion criteria. The pooled result of 13 studies reported that eHealth intervention significantly affected the reduction of systolic blood pressure (mean difference [MD]: -5.96 mmHg, 95% confidence interval [CI]: -9.21 to -2.70, p < .001) and diastolic blood pressure (MD: -3.35 mmHg, 95% CI: -6.36 to -0.35, p < .05). eHealth interventions significantly decreased the proportion of patients with inadequate blood pressure control (risk ratio: 0.69, 95% CI: 0.57-0.84, p < .001) and their body weight (MD: -1.08 kg, 95% CI: -2.04 to -0.13, p < .05). Regarding self-care behavioural outcomes, the pooled results show that eHealth interventions significantly reduced the sodium intake. CONCLUSIONS This study reported that eHealth interventions positively affect blood pressure control and thus could be a promising alternative in the management of hypertension. However, their effectiveness on self-care behavioural change and psychosocial well-being is insufficient. Therefore, additional eHealth interventions with rigorous experimental design on hypertension self-care are needed to provide a robust evidence for a wide population and to address the increasing health care needs of patients with hypertension.
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Affiliation(s)
- Yue Ma
- The Chinese University of Hong Kong, 6/F, Esther Lee Building, The Nethersole School of Nursing, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Ho Yu Cheng
- The Chinese University of Hong Kong, 8/F, Esther Lee Building, The Nethersole School of Nursing, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Li Cheng
- Sun Yat-Sen University, Room 425, School of Nursing, Guangzhou, China.
| | - Janet W H Sit
- The Chinese University of Hong Kong, 7/F, Esther Lee Building, The Nethersole School of Nursing, Shatin, N.T., Hong Kong Special Administrative Region.
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14
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Bright KS, Ginn C, Keys EM, Brockway ML, Tomfohr-Madsen L, Doane S, Benzies K. Study Protocol: Determining Research Priorities of Young Albertan Families (The Family Research Agenda Initiative Setting Project-FRAISE)-Participatory Action Research. Front Public Health 2018; 6:228. [PMID: 30211143 PMCID: PMC6121170 DOI: 10.3389/fpubh.2018.00228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pregnancy and childrearing can be an exciting and stressful time for new parents. The maternal-child health landscape has changed dramatically over the last few decades and research priorities need to address these rapid changes. There have been limited attempts to engage and collaborate with members of the public to develop research priorities for families who are expecting or parenting an infant to age 24 months. The work that has been completed has attempted to identify parental preference for information delivery and barriers to uptake of parenting programs but has not investigated parental research priorities. Methods: In collaboration with provincial research units and strategic clinical networks (SCN), we will use principles of participatory action research (PAR) as our theoretical framework/method, and a modified James Lind Alliance priority setting approach to prioritize a list of research questions that parents/knowledge users believe will support the health of their families. This will result in a top 10 list of parent/knowledge user-identified research priorities. This project will consist of three phases. In the first phase, we developed a steering committee of parents/knowledge users, healthcare providers, community agencies, and researchers to design a survey about health priorities for families. In the second phase, we will distribute the survey to diverse groups of parents/knowledge users/providers and hold a series of meetings to identify and prioritize potential questions from new parents about health issues from conception to age 24 months. In the third phase, we will collaboratively disseminate and translate findings. Discussion: This study will highlight parental health concerns and recommend parent-identified research priorities to inform future research projects needed to support the health of families between conception to age 24 months. Understanding the health research priorities of families in the community will help ensure future research contributes to meaningful changes in the health of young children, parents/knowledge users, and families. Ethics: This study and protocol have received ethical approved from the Conjoint Health Research Ethics Board at the University of Calgary (REB17-0014). Dissemination: The top 10 research priorities will be published and additional findings from the study will be distributed through pamphlets and newsletters.
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Affiliation(s)
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Stephanie Doane
- FRAISE Steering Committee, University of Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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15
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Noone C, Dwyer CP, Murphy J, Newell J, Molloy GJ. Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis. Syst Rev 2018; 7:128. [PMID: 30131071 PMCID: PMC6103808 DOI: 10.1186/s13643-018-0791-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/31/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension. METHODS A systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure. DISCUSSION This study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017070579.
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Affiliation(s)
- C. Noone
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - C. P. Dwyer
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Murphy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - G. J. Molloy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
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