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Abe M, Hirata T, Morito N, Kawashima M, Yoshida S, Takami Y, Fujimoto T, Kawasoe S, Shibukawa T, Segawa H, Yamanokuchi T, Ishida S, Takahashi K, Tada K, Kato Y, Sakima A, Arima H. Smartphone application-based intervention to lower blood pressure: a systematic review and meta-analysis. Hypertens Res 2024:10.1038/s41440-024-01939-6. [PMID: 39396072 DOI: 10.1038/s41440-024-01939-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/11/2024] [Accepted: 09/23/2024] [Indexed: 10/14/2024]
Abstract
Nowadays, the mHealth market is flooded with smartphone applications (apps) lacking validation for blood pressure (BP)-lowering effects and BP measurement accuracy. This systematic review for Guidelines for BP control using digital technologies of the Japanese Society of Hypertension aimed to assess the validation studies of apps. We searched eligible studies in Ovid MEDLINE, Cochrane Library, and Ichushi, focusing on randomized controlled trials and observational studies comparing the effects of smartphone app-based interventions with non-digital healthcare. Random effects models of meta-analysis were employed to estimate the pooled effects of mean BP change and 95% confidence intervals (CIs). Out of 7385 studies screened, 76 studies with 46,459 participants were included. The interventions were significantly associated with a reduction in office systolic and diastolic BP at six months (systolic BP, -2.76 mmHg, 95% CI: -3.94 to -1.58; diastolic BP, -1.23 mmHg, -1.80 to -0.67). Normotensives saw a significant reduction in office systolic BP at three-month (-4.44 mmHg, -6.96 to -1.92), diminishing afterward (six-month, 0.86 mmHg, -2.81 to 4.52; twelve-month, 0.86 mmHg, -2.81 to 4.52). Conversely, hypertensive participants experienced a significant reduction in office systolic BP at both three- and six-month (three-month, -7.71 mmHg, -10.63 to -4.79; six-month, -1.88 mmHg, -3.41 to -0.35), albeit with limited evidence thereafter. A larger BP reduction was observed among participants using apps with wireless transmission of BP measurements (P = 0.047 for interaction), while there was no clear difference in BP reduction according to the presence of other functions. Smartphone app-based interventions may hold the potential to improve BP levels.
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Affiliation(s)
- Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tetsuo Hirata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Natsumi Morito
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Clinical Laboratory and Transfusion, Fukuoka University Hospital, Fukuoka, Japan
| | - Megumi Kawashima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Sumiko Yoshida
- Department of Clinical Research, National Hospital Organization (NHO) Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taku Fujimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takeshi Shibukawa
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Hiroyoshi Segawa
- Department of Nephrology, Omihachiman Community Medical Center, Shiga, Japan
| | - Toshitaka Yamanokuchi
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Shintaro Ishida
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Koji Takahashi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuhiro Tada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshifumi Kato
- Department of General Medicine, Faculty of Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
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Bandeira ACN, Gama de Melo PU, Johann EB, Ritti-Dias RM, Rech CR, Gerage AM. Effect of m-Health-Based Interventions on Blood Pressure: An Updated Systematic Review with Meta-Analysis. Telemed J E Health 2024; 30:2402-2418. [PMID: 38946603 DOI: 10.1089/tmj.2023.0545] [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] [Indexed: 07/02/2024] Open
Abstract
Background: In recent years, the integration of mobile health (m-Health) interventions has garnered increasing attention as a potential means to improve blood pressure (BP) management in adults. This updated systematic review with meta-analysis aimed to identify the effect of m-Health-based interventions on BP in adults and to evaluate the effect of m-Health on BP according to the characteristics of subjects, interventions, and countries. Methods: The search was carried out in PubMed, Embase, ResearchGate, and Cochrane databases in January 2022. Study selection and data extraction were performed by two independent reviewers. For analysis, random effects models were used with a confidence interval (CI) of 95% and p < 0.05. Results: Fifty studies were included in this review and in the meta-analysis. Interventions with m-Health reduced systolic BP in 3.5 mmHg (95% CI -4.3; -2.7; p < 0.001; I2 = 85.8%) and diastolic BP in 1.8 mmHg (95% CI -2.3; -1.4; p < 0.001; I2 = 78.9%) compared to usual care. The effects of m-Health interventions on BP were more evident in men and in older adults, in interventions lasting 6-8 weeks, with medication reminders, with the possibility of insertion of BP values (p < 0.05). Conclusion: The results of this study support the effectiveness of m-Health in reducing BP when compared to standard care. However, these effects are dependent on the characteristics of the subjects and interventions. Given the substantial heterogeneity among the results of this systematic review with meta-analysis, its interpretation should be cautious. Future research on this topic is warranted.
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Affiliation(s)
- Antonio Cleilson Nobre Bandeira
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Paulo Urubatan Gama de Melo
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eduardo Braghini Johann
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Cassiano Ricardo Rech
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Aline Mendes Gerage
- Graduate Program in Physical Education, Sports Center, Research Group in Clinical Exercise, Federal University of Santa Catarina, Florianópolis, Brazil
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Kengne AP, Brière JB, Gudiña IA, Jiang X, Kodjamanova P, Bennetts L, Khan ZM. The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:807-816. [PMID: 38366854 DOI: 10.1080/14737167.2024.2319598] [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: 07/19/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia. METHODS We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2. RESULTS Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence. CONCLUSIONS Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.
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Affiliation(s)
| | | | | | - Xiaobin Jiang
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Liga Bennetts
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
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Yap HJ, Lim JJJ, Tan SYD, Ang CS. Effectiveness of digital health interventions on adherence and control of hypertension: a systematic review and meta-analysis. J Hypertens 2024; 42:1490-1504. [PMID: 38973553 DOI: 10.1097/hjh.0000000000003793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Hypertension, a risk factor for developing cardiovascular disease, is becoming increasingly prevalent worldwide. Digital health is now widely utilized for hypertension management, and numerous studies have assessed its effectiveness. OBJECTIVE The review aims to analyse the effectiveness of digital health (i.e., mobile health (mHealth), telehealth, and the combination of mHealth & telehealth) on hypertensive patients, concerning three key areas: clinical outcomes, medication adherence, and adherence to lifestyle changes, as compared to standard care. METHODS The review followed the PRISMA framework. Eight electronic databases were scanned for randomized control trials focusing on the effects of mHealth or telehealth on hypertensive patients, published between 2010 and 2023. All processes were conducted by the first two authors independently. A meta-analysis was conducted for quantitative data, while a narrative synthesis was conducted for qualitative data. RESULTS In total, 74 studies involving 92 686 participants were identified. The meta-analysis favoured the interventions, revealing a significant decrease in systolic blood pressure and diastolic blood pressure for mHealth, telehealth and mHealth & telehealth groups. Nevertheless, medication adherence showed improvement only in the mHealth group, while blood pressure control showed improvement in both mHealth and mHealth & telehealth groups, and BMI showed improvement only in the mHealth group. Evidence for adherence to physical activity and DASH diet/salt intake remained inconclusive. CONCLUSION In general, mHealth and telehealth have demonstrated their merits in improving the clinical outcomes of hypertensive patients.
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Affiliation(s)
- Hao Jeun Yap
- Department of Pharmacy, National University of Singapore
| | | | | | - Chin Siang Ang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Ye H, Lin L, Zhong D, Chen P, He X, Luo Z, Chen P. The impact of telehealth education on self-management in patients with coexisting type 2 diabetes mellitus and hypertension: a 26-week randomized controlled trial. J Endocrinol Invest 2024; 47:2361-2369. [PMID: 38351401 DOI: 10.1007/s40618-024-02310-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/11/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND The prevalence of coexisting type 2 diabetes mellitus and hypertension is increasing globally and posing significant health challenges. Effective self-management is crucial for controlling the disease and preventing complications. Telehealth education has emerged as a promising approach to enhancing self-management. OBJECTIVE This study aimed to investigate the effects of telehealth education on glycolipid metabolism, blood pressure, and self-management in patients with coexisting type 2 diabetes mellitus and hypertension. METHODS This study included 174 patients diagnosed with type 2 diabetes and hypertension from October 2022 to March 2023 at the 900th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army. The patients were randomly assigned to the control group or the telehealth education group. The control group received conventional diabetes education including diet and exercise guidance, while the telehealth education group received additional online education through the WeChatapplication. Both groups were followed up for 26 weeks and the changes in glycolipid metabolism, blood pressure, and self-management were compared between the groups. RESULTS After 26 weeks of intervention, the telehealth education group showed statistically significant reductions in weight, body mass index, fasting blood glucose, 2 h postprandial blood glucose, and hemoglobin A1c compared to the control group (P < 0.05). The telehealth education group also exhibited a significant decrease in systolic blood pressure and low-density lipoprotein-C level (P < 0.05). The Summary of Diabetes Self-Care Activities score, which reflects the level of diabetes self-management, demonstrated that the telehealth education group had a significantly better total score as well as superior scores in all five sub-categories (diet, blood glucose testing, medication use, and foot care) compared to the control group (P < 0.05). CONCLUSION Our findings confirmed that telehealth education effectively enhanced the self-management capabilities of patients with coexisting type 2 diabetes and hypertension, leading to better glycolipid and blood pressure control. The use of telehealth education may potentially improve the interaction between medical staff and patients in the management of chronic diseases.
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Affiliation(s)
- Hongjiang Ye
- The 900th Hospital of Joint Logistic Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ling Lin
- The 900th Hospital of Joint Logistic Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Dongmei Zhong
- The 900th Hospital of Joint Logistic Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Pin Chen
- The 900th Hospital of Joint Logistic Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiaoqiong He
- The 900th Hospital of Joint Logistic Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zhurong Luo
- The 900th Hospital of Joint Logistic Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China.
| | - Ping Chen
- The 904th Hospital of Joint Logistics Surport Force, PLA, Changzhou, China.
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Sakima A, Akagi Y, Akasaki Y, Fujii T, Haze T, Kawakami-Mori F, Kitajima K, Kobayashi Y, Matayoshi T, Sakaguchi T, Yamazato M, Abe M, Ohya Y, Arima H. Effectiveness of digital health interventions for telemedicine/telehealth for managing blood pressure in adults: a systematic review and meta-analysis. Hypertens Res 2024:10.1038/s41440-024-01792-7. [PMID: 38977877 DOI: 10.1038/s41440-024-01792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024]
Abstract
This systematic review and meta-analysis included randomized controlled trials or observational studies that compare digital health interventions (DHIs) for telemedicine/telehealth versus usual care for managing blood pressure (BP) in adults. We searched PubMed, Cochrane CENTRAL, and IchuShi-Web, and used a random-effects meta-analysis of the weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 117 studies with 68677 participants as eligible. The 3-month intervention period reduced office systolic BP (SBP) compared with usual care in 38 studies (MD: -3.21 mmHg [95% confidence interval: -4.51 to -1.90]), with evidence of heterogeneity. Office SBP across intervention periods demonstrated comparable effects (3-, 6- [54 studies], 12- [43 studies], and >12-month periods [9 studies]). The benefits for office diastolic BP were similar to those for office SBP. Additionally, the interventions significantly reduced the office SBP compared with the control, regardless of the mode of intervention delivery (smartphone apps [38 studies], text messages [35 studies], and websites [34 studies]) or type of facility (medical [74 studies] vs. non-medical [33 studies]). The interventions were more effective in 41 hypertension cohorts compared with 66 non-hypertension cohorts (-4.81 mmHg [-6.33, -3.29] vs. -2.17 mmHg [-3.15, -1.19], P = 0.006 for heterogeneity). In conclusion, DHIs for telemedicine/telehealth improved BP management compared with usual care. The effectiveness with heterogeneity should be considered, as prudent for implementing evidence-based medicine. This meta-analysis considered 117 studies with 68677 participants eligible. The DHIs for telemedicine/telehealth reduced office BP compared with usual care, regardless of intervention duration, intervention delivery mode, facility type, and cohort type. Additionally, the DHIs reduced the risk of uncontrolled BP compared with usual care, regardless of intervention duration, intervention delivery mode, and facility type. BP blood pressure, DHI digital health intervention, MD mean difference, RR risk ratio, SBP systolic blood pressure.
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Affiliation(s)
- Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan.
| | - Yuya Akagi
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takako Fujii
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tatsuya Haze
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Kanagawa, Japan
| | - Fumiko Kawakami-Mori
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ken Kitajima
- Department of Cardiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Kobayashi
- Co-Creation Innovation Center, Yokohama City University, Kanagawa, Japan
| | | | - Takashi Sakaguchi
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Ohya
- University Hospital of the Ryukyus, Okinawa, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Boima V, Doku A, Agyekum F, Tuglo LS, Agyemang C. Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine 2024; 69:102432. [PMID: 38333367 PMCID: PMC10850120 DOI: 10.1016/j.eclinm.2024.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Background Digital health interventions can be effective for blood pressure (BP) control, but a comparison of the effectiveness and application of these types of interventions has not yet been systematically evaluated in low- and middle-income countries (LMICs). This study aimed to compare the effectiveness of digital health interventions according to the World Health Organisation (WHO) classifications of patients in terms of BP control, lifestyle behaviour changes, and adherence to medication in patients with hypertension in LMICs. Methods In this systematic review and meta-analysis, we searched the PubMed, Scopus, Web of Science, Embase, CINAHL, and Cochrane Library databases for randomised controlled trials (RCTs) published in English, comprised of adults (≥18 years old) with hypertension and the intervention consisted of digital health interventions according to WHO's classifications for patients in LMICs between January 1, 2009, and July 17, 2023. We excluded RCTs that considered patients with hypertension comorbidities such as diabetes and hypertension-mediated target organ damage (HMTOD). The references were downloaded into Mendeley Desktop and imported into the Rayyan web tool for deduplication and screening. The risk of bias was assessed using Cochrane Risk of Bias 2. Data extraction was done according to Cochrane's guidelines. The main outcome measures were mean systolic blood pressure (SBP) and BP control which were assessed using the random-effect DerSimonian-Laird and Mantel-Haenszel models. We presented the BP outcomes, lifestyle behaviour changes and medication adherence in forest plots as well as summarized them in tables. This study is registered with PROSPERO, CRD42023424227. Findings We identified 9322 articles, of which 22 RCTs from 12 countries (n = 12,892 respondents) were included in the systematic review. The quality of the 22 studies was graded as high risk (n = 7), had some concerns (n = 3) and low risk of bias (n = 12). A total of 19 RCTs (n = 12,418 respondents) were included in the meta-analysis. Overall, digital health intervention had significant reductions in SBP [mean difference (MD) = -4.43 mmHg (95% CI -6.19 to -2.67), I2 = 92%] and BP control [odds ratio (OR) = 2.20 (95% CI 1.64-2.94), I2 = 78%], respectively, compared with usual care. A subgroup analysis revealed that short message service (SMS) interventions had the greatest statistically significant reduction of SBP [MD = -5.75 mm Hg (95% Cl -7.77 to -3.73), I2 = 86%] compared to mobile phone calls [MD = 3.08 mm Hg (-6.16 to 12.32), I2 = 87%] or smartphone apps interventions [MD = -4.06 mm Hg (-6.56 to -1.55), I2 = 79%], but the difference between groups was not statistically significant (p = 0.14). The meta-analysis showed that the interventions had a significant effect in supporting changes in lifestyle behaviours related to a low salt diet [standardised mean difference (SMD) = 1.25; (95% CI 0.64-1.87), I2 = 89%], physical activity [SMD = 1.30; (95% CI 0.23-2.37), I2 = 94%] and smoking reduction [risk difference (RR) = 0.03; (95% CI 0.01-0.05), I2 = 0%] compared to the control group. In addition, improvement in medication adherence was statistically significant and higher in the intervention group than in the control group [SMD = 1.59; (95% CI 0.51-2.67), I2 = 97%]. Interpretation Our findings suggest that digital health interventions may be effective for BP control, changes in lifestyle behaviours, and improvements in medication adherence in LMICs. However, we observed high heterogeneity between included studies, and only two studies from Africa were included. The combination of digital health interventions with clinical management is crucial to achieving optimal clinical effectiveness in BP control, changes in lifestyle behaviours and improvements in medication adherence. Funding None.
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Affiliation(s)
- Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public & Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public & Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Lawrence Sena Tuglo
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Department of Epidemiology, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, China
| | - Charles Agyemang
- Department of Public & Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chen Y, Luo F, Han L, Qin Q, Zeng Q, Zhou X, Huang Y, Gao Q, Wang W, Shi Q, Wang Q, Yu Z, Wang T, Jiang J. Centralized health management based on hot spring resort improves physical examination indicators and sleep quality in people at high risk of chronic diseases: a randomized controlled trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:2011-2024. [PMID: 37801161 DOI: 10.1007/s00484-023-02558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/20/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
We study the effects of centralized health management based on hot spring resorts on the physical examination index and sleep quality of people at high risk of chronic diseases. We recruited 114 volunteers at high risk of chronic diseases. We then divided them into 57 in the intervention group and 57 in the control group. The intervention group collectively received 4 weeks (28 days) of comprehensive health management interventions at Tongjing Hotspring Resort, including regular schedules, balanced diet, appropriate exercise, targeted health education, etc. The main outcomes are physical examination indicators (height, weight, waist circumference, blood pressure, lipids, and glucose) and sleep quality. Both groups underwent a questionnaire and physical examination at baseline, 2 weeks and 4 weeks. Intragroup comparisons grouped by exposure criteria showed decreases in BMI, waist circumference, triglycerides, total cholesterol, and blood glucose in the intervention group at both 2 and 4 weeks (all P < 0.05); however, in the control group, only triglycerides decreased at 4 weeks (P < 0.05). Intergroup comparisons showed BMI and waist circumference were significantly lower in the intervention group than in the control group at 4 weeks (all P < 0.05). Intragroup comparisons of insomnia severity index (ISI) scores showed a significant decrease in the intervention group at both 2 and 4 weeks (all P < 0.001) with no significant change in the control group (P > 0.05). Intergroup comparisons showed that the insomnia severity index (ISI) scores were significantly higher in the intervention group than in the control group at baseline (P = 0.006) but became significantly lower than the control group at 2 and 4 weeks (all P < 0.001). Thus, this pattern significantly improved BMI, waist circumference, triglycerides, and sleep in the intervention group. TRIAL REGISTRATION NUMBER: Chinese Clinical Trials Registry: ChiCTR2100053201, registered 14 Nov 2021. (Retroactive Registration).
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Affiliation(s)
- Yu Chen
- School of Public Health, Chongqing Medical University, Chongqing, China.
| | - Fan Luo
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Lingli Han
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qizhong Qin
- Experimental Teaching Management Center, Chongqing Medical University, Chongqing, China
| | - Qing Zeng
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xiangjun Zhou
- Institute for Infectious Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Huang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qiuyidi Gao
- School of Public Health, University of California, Berkeley, CA, USA
| | - Wen Wang
- Department of Internal Medicine, Nan'an District People's Hospital of Chongqing, Chongqing, China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qirui Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Zhaoxia Yu
- Medical Department, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ting Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jishan Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
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9
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Siopis G, Moschonis G, Eweka E, Jung J, Kwasnicka D, Asare BYA, Kodithuwakku V, Willems R, Verhaeghe N, Annemans L, Vedanthan R, Oldenburg B, Manios Y. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health 2023; 5:e144-e159. [PMID: 36828607 DOI: 10.1016/s2589-7500(23)00002-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. FINDINGS Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. INTERPRETATION SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility. FUNDING European Union's Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- George Siopis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Evette Eweka
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Vimarsha Kodithuwakku
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium; Research Institute for Work and Society, HIVA KU Leuven, Leuven, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC, Australia; NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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