scholarly journals The Effect of Smartphone App–Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis (Preprint)

2020 ◽  
Author(s):  
Hongxuan Xu ◽  
Huanyu Long
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Meta Analysis ◽  
Blood Pressure Reduction ◽  
Pooled Analysis ◽  
Lifestyle Changes ◽  
Mean Difference ◽  
Smartphone App ◽  
Smartphone Intervention

BACKGROUND Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. OBJECTIVE The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. RESULTS Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference –2.28, 95% CI –3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (<i>P</i>&lt;.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I<sup>2</sup>=0%). No difference between groups was demonstrated with respect to physical activity. CONCLUSIONS A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction.

scholarly journals The Effect of Smartphone App–Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis

10.2196/21759 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e21759
Author(s):  
Hongxuan Xu ◽  
Huanyu Long
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Meta Analysis ◽  
Blood Pressure Reduction ◽  
Pooled Analysis ◽  
Lifestyle Changes ◽  
Mean Difference ◽  
Smartphone App ◽  
Smartphone Intervention

Background Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference –2.28, 95% CI –3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I2=0%). No difference between groups was demonstrated with respect to physical activity. Conclusions A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction.

scholarly journals The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis

10.2196/17776 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e17776 ◽  
Author(s):  
Ran Li ◽  
Ning Liang ◽  
Fanlong Bu ◽  
Therese Hesketh
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Health Care ◽  
Medication Adherence ◽  
Mobile Health ◽  
Meta Analysis ◽  
Self Management ◽  
Narrative Synthesis ◽  
Management Behavior ◽  
Mhealth Intervention

Background Effective treatment of hypertension requires careful self-management. With the ongoing development of mobile technologies and the scarcity of health care resources, mobile health (mHealth)–based self-management has become a useful treatment for hypertension, and its effectiveness has been assessed in many trials. However, there is a paucity of comprehensive summaries of the studies using both qualitative and quantitative methods. Objective This systematic review aimed to measure the effectiveness of mHealth in improving the self-management of hypertension for adults. The outcome measures were blood pressure (BP), BP control, medication adherence, self-management behavior, and costs. Methods A systematic search was conducted using 5 electronic databases. The snowballing method was used to scan the reference lists of relevant studies. Only peer-reviewed randomized controlled trials (RCTs) published between January 2010 and September 2019 were included. Data extraction and quality assessment were performed by 3 researchers independently, adhering to the validation guideline and checklist. Both a meta-analysis and a narrative synthesis were carried out. Results A total of 24 studies with 8933 participants were included. Of these, 23 studies reported the clinical outcome of BP, 12 of these provided systolic blood pressure (SBP) and diastolic blood pressure (DBP) data, and 16 articles focused on change in self-management behavior and medication adherence. All 24 studies were included in the narrative synthesis. According to the meta-analysis, a greater reduction in both SBP and DBP was observed in the mHealth intervention groups compared with control groups, −3.78 mm Hg (P<.001; 95% CI −4.67 to −2.89) and −1.57 mm Hg (P<.001; 95% CI −2.28 to −0.86), respectively. Subgroup analyses showed consistent reductions in SBP and DBP across different frequencies of reminders, interactive patterns, intervention functions, and study duration subgroups. A total of 16 studies reported better medication adherence and behavioral change in the intervention groups, while 8 showed no significant change. Six studies included an economic evaluation, which drew inconsistent conclusions. However, potentially long-term financial benefits were mentioned in all economic evaluations. All studies were assessed to be at high risk of bias. Conclusions This review found that mHealth self-management interventions were effective in BP control. The outcomes of this review showed improvements in self-management behavior and medication adherence. The most successful mHealth intervention combined the feature of tailored messages, interactive communication, and multifaceted functions. Further research with longer duration and cultural adaptation is necessary. With increasing disease burden from hypertension globally, mHealth offers a potentially effective method for self-management and control of BP. mHealth can be easily integrated into existing health care systems. Trial Registration PROSPERO CRD42019152062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=152062

scholarly journals Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis

2019 ◽  
Vol 35 (12) ◽  
Author(s):  
Elma Izze da Silva Magalhães ◽  
Bruno Andrade de Sousa ◽  
Natália Peixoto Lima ◽  
Bernardo Lessa Horta
Keyword(s):  
Systematic Review ◽  
Body Mass Index ◽  
Body Mass ◽  
Maternal Smoking ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Mean Difference ◽  
Smoking During Pregnancy ◽  
Smoking In Pregnancy ◽  
Maternal Smoking During Pregnancy

Abstract: The present study aimed to conduct a systematic review and meta-analysis to evaluate the evidence on the association of maternal smoking during pregnancy with offspring body composition in childhood, adolescence and adulthood. MEDLINE, Web of Science and LILACS databases were searched. Reference lists were also screened. We included original studies, conducted in humans, that assessed the association of maternal smoking during pregnancy with offspring body mass index (BMI) and overweight in childhood, adolescence and adulthood, published through May 1st, 2018. A meta-analysis was used to estimate pooled effect sizes. The systematic review included 64 studies, of which 37 evaluated the association of maternal smoking during pregnancy with overweight, 13 with BMI, and 14 evaluated both outcomes. Of these 64 studies, 95 measures of effect were extracted and included in the meta-analysis. We verified that the quality of evidence across studies regarding maternal smoking in pregnancy and overweight and BMI of offspring to be moderate and low, respectively. Most studies (44 studies) were classified as moderate risk bias. Heterogeneity among studies included was high and, in the random-effects pooled analysis, maternal smoking during pregnancy increased the odds of offspring overweight (OR: 1.43, 95%CI: 1.35; 1.52) and mean difference of BMI (β: 0.31, 95%CI: 0.23; 0.39). In conclusion, offspring of mothers who smoked during pregnancy have higher odds of overweight and mean difference of BMI, and these associations persisted into adulthood.

scholarly journals Effect of Isometric Exercise on Blood Pressure in Pre-Hypertensive and Hypertensive Individuals: Protocol for a Systematic Review and Meta-analysis of Randomized Clinical Trials

2021 ◽  
Author(s):  
Patricia Caetano Oliveira ◽  
Alexandre Machado Lehnen ◽  
Gustavo Waclawovsky
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Clinical Trials ◽  
Exercise Training ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Isometric Exercise ◽  
Lifestyle Changes ◽  
Dynamic Resistance ◽  
Isometric Handgrip

Abstract BackgroundSystemic arterial hypertension (HTN) is the leading risk factor of cardiovascular disease death. Lifestyle changes are key for the prevention and management of HTN. Regular aerobic exercise training is recommended as part of the management of HTN; and dynamic resistance exercise should be prescribed as an adjuvant to aerobic training. Recent evidence points to potential benefits of isometric resistance training in reducing blood pressure (BP). Yet, the hypotensive effect of isometric exercise in pre-hypertensive and hypertensive individuals is not fully understood. Thus, we will examine the effect of isometric exercise in pre-hypertensive and hypertensive individuals through a systematic review and meta-analysis. MethodsOur systematic review study will include randomized clinical trials (RCTs) selected from the electronic databases MEDLINE (PubMed), Cochrane, LILACS, EMBASE and PEDro published in English, Spanish and Portuguese language. We will follow the PRISMA guidelines and PICOS framework. Our search will involve studies with both male and female participants aged 18 years or more diagnosed with prehypertension or HTN performing one session of isometric exercise (acute effect) or isometric exercise training (chronic effect) compared to a control group (no exercise). We will use Cochrane Risk of Bias 2 (RoB 2) tool to evaluate the quality of the studies and RStudio software (v1.3.959 for Windows) for statistical analyses. DiscussionA meta-analysis of a homogeneous sample of pre-hypertensive and hypertensive individuals involving isometric handgrip exercise alone can further support previous findings and improve our understanding and recommendations for the management of these populations. Systematic review registrationThe study protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42020213081).

scholarly journals Effectiveness of Interventions To Enable Hypertension Medication Adherence In Low-And Middle-Income Countries: A Systematic Review And Meta-analysis

2021 ◽  
Author(s):  
Olivia Nakwafila ◽  
Benn Sartorius ◽  
Sphamandla Josias Nkambule ◽  
Tivani Mashamba Thompson
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Meta Analysis ◽  
Pharmacological Interventions ◽  
Middle Income ◽  
Quality Of Evidence ◽  
Middle Income Countries ◽  
Secondary Outcomes

Abstract Background: In recent decades low- and middle-income countries (LMICs) are witnessing an increase in hypertension and thus becoming a significant public health issue due to associated Cardiovascular disease (CVD) outcomes. Antihypertensive medication adherence is crucial to controlling blood pressure; therefore, this systematic review aimed to evaluate the effectiveness of non-pharmacological interventions on improving blood pressure control and medication adherence in patients with hypertension in LMICs.Methods: We searched the following databases for relevant literature published between Jan 2005 – Dec 2020: PubMed, EBSCOhost included Academic Search; CINAHL and MEDLINE complete; PubMed; WEB of Science; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews and Google Scholar. Cochrane risk of bias tool (RoB 2) was used to appraise included studies critically, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to measure the quality of evidence. We conducted a meta‑analysis using DrSimonian-Laid's random-effect model at 95% confidence intervals (CIs). The secondary outcomes of interests were synthesised descriptively as changes in BP adherence outcomes. Results: We identified 14 eligible randomised controlled trials that presented blood pressure (BP) effectiveness and medication adherence among BP patients aged between 18-75 years. The overall quality of evidence with the majority of trials was moderate. Meta weighed effect (SBP) for 12/14 studies was -4.74 (95% CI:-6.07 to -3.47) and I2 = 57%. Out of 14 eligible studies, (86%) suggested a significant improvement in the proportion of patients with controlled blood pressure (BP < 140/90mmHG) with a positive effect on secondary outcomes such as quality of life.Conclusion: Non-pharmacological interventions could be effective in managing hypertension. In recommending the need to investigate the feasibility of non-pharmacological evidence in specific LMIC settings, focus should be on an intervention strategy consisting of an educational intervention directed toward the patients, health professionals and organisation. Considering heterogeneity, randomised trials that are well-designed with larger sample sizes are encouraged in LMICs` to help policymakers make well-informed decisions on hypertension management.Systematic review Registration: PROSPERO registration number: CRD42020172954

scholarly journals Efficacy of SGLT2 inhibitors in glycemic control, weight loss and blood pressure reduction: a systematic review and meta-analysis

2015 ◽  
Vol 7 (Suppl 1) ◽  
pp. A58 ◽  
Author(s):  
Lana Pinto ◽  
Dimitris Rados ◽  
Luciana Remonti ◽  
Caroline Kramer ◽  
Cristiane Leitao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Weight Loss ◽  
Glycemic Control ◽  
Meta Analysis ◽  
Blood Pressure Reduction ◽  
Sglt2 Inhibitors ◽  
Pressure Reduction
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