Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta‐Analysis of Randomized Clinical Trials

Gautam Satheesh; Rupasvi Dhurjati; Vivekanand Jha; Aletta E. Schutte; Bolanle Banigbe; Dorairaj Prabhakaran; Andrew E. Moran; Abdul Salam

doi:10.1111/jch.14950

journal article Open Access Dec 10, 2024

Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta‐Analysis of Randomized Clinical Trials

Gautam Satheesh

Rupasvi Dhurjati Vivekanand Jha

Aletta E. Schutte

Bolanle Banigbe Dorairaj Prabhakaran

Andrew E. Moran

Abdul Salam

The Journal of Clinical Hypertension Vol. 27 No. 1 · Wiley

View at Publisher Save 10.1111/jch.14950

Abstract

ABSTRACTLarge gaps persist in the diagnosis, awareness, treatment, and control of hypertension globally. Standardized treatment protocols (STPs) have been widely proposed to guide hypertension treatment, particularly in primary healthcare settings. However, there has been no review that quantifies the effects of hypertension STPs on blood pressure (BP) reduction and control. We conducted a systematic review of randomized clinical trials (RCTs) among adults with hypertension, comparing hypertension STPs (intervention) with usual care (comparator) for effects on BP. Relevant RCTs were identified by searching multiple electronic databases. Random‐effects meta‐analyses were conducted to evaluate between‐group differences in systolic BP reduction (primary outcome), diastolic BP reduction, BP control, and adverse events (AEs). Sixteen RCTs involving 59,945 participants (baseline mean BP: 149/91 mmHg) were included. Reductions in systolic and diastolic BP with STPs compared to usual care were 6.7 (95% CI 3.7–9.8) mmHg and 2.6 (1.2–4.1) mmHg, respectively (p < 0.001 for both). BP control achieved was 57% in the STP group compared to 24% in the usual care group (p < 0.001). The overall incidence of any AEs was 14.5% versus 13.5% (RR 1.27 [0.88–1.82]) with STPs and usual care, respectively. In summary, interventions involving hypertension STPs significantly reduce systolic and diastolic BP and improve BP control compared to usual care. STPs can, therefore, be an efficient strategy to implement evidence‐based treatments and upscale treatment coverage, given the large untreated and uncontrolled hypertension burdens globally.

Topics

No keywords indexed for this article. Browse by subject →

References

39

[1]

10.1016/s0140-6736(18)33216-1

[2]

GBD 2017 Causes of Death Collaborators "Global, Regional, and National age‐sex‐Specific Mortality for 282 Causes of Death in 195 Countries and Territories, 1980‐2017: A Systematic Analysis for the Global Burden of Disease Study 2017" Lancet (2019)

[3]

Global Disparities of Hypertension Prevalence and Control

Katherine T. Mills, Joshua D. Bundy, Tanika N. Kelly et al.

Circulation 10.1161/circulationaha.115.018912

[4]

World Health Organization (2023)

[5]

(2018)

[6]

Resolve to Save Lives. Improve Heart Health: Hypertension [Internet]. New York: Resolve to Save Lives. [Cited 2023 May 4] https://resolvetosavelives.org/cardiovascular‐health/hypertension.

[7]

G.Satheesh R.Dhurjati andA.Salam.INPLASY Protocol 202380021: Efficacy and Safety of Standard Treatment Protocols for Blood Pressure Reduction Compared With Usual Care: A Systematic Review and Meta‐Analysis of Randomised Trials.2023 https://inplasy.com/inplasy‐2023‐8‐0021/.

[8]

10.7326/m17‐1805

[9]

10.1002/14651858.cd005182

[10]

Glynn L. G. "Interventions Used to Improve Control of Blood Pressure in Patients With Hypertension" Cochrane Database of Systematic Reviews (Online) (2010)

[11]

10.1097/01.mlr.0000220260.30768.32

[12]

10.3399/bjgp10x544113

[13]

10.1136/bmj.c3995

[14]

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

J. P. T. Higgins, D. G. Altman, P. C. Gotzsche et al.

BMJ 10.1136/bmj.d5928

[15]

10.1016/s0140-6736(22)00325-7

[16]

10.1016/0021-9681(77)90077-7

[17]

10.1016/s0140-6736(79)92397-3

[18]

10.1016/0091-7435(79)90024-0

[19]

10.1161/01.cir.82.5.1616

[20]

10.1016/s0895-7061(96)00305-6

[21]

10.1016/s1086-5802(16)30371-0

[22]

10.1080/1356182031000122852

[23]

10.1016/s0895-7061(03)01034-3

[24]

10.1592/phco.23.2.209.32096

[25]

10.1016/j.amjhyper.2004.06.006

[26]

10.1503/cmaj.050030

[27]

10.1161/hypertensionaha.109.134874

[28]

10.1161/hypertensionaha.108.123455

[29]

10.2471/blt.08.062364

[30]

10.1097/hjh.0b013e3283619d6a

[31]

10.1111/jch.12861

[32]

10.26633/rpsp.2022.153

[33]

10.5334/gh.1082

[34]

10.26633/rpsp.2022.125

[35]

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

New England Journal of Medicine 10.1056/nejmoa1511939

[36]

10.1038/s41371-022-00742-5

[37]

10.1136/heartjnl-2024-324253

[38]

10.1097/hjh.0000000000003636

[39]

10.1038/s41371-022-00766-x

Metrics

8

Citations

39

References

Details

Published: Dec 10, 2024
Vol/Issue: 27(1)
License: View

Authors

G

Gautam Satheesh

The George Institute for Global Health Hyderabad Telangana India

R

Rupasvi Dhurjati

The George Institute for Global Health Hyderabad Telangana India

V

Vivekanand Jha

The George Institute for Global Health University of New South Wales Sydney New South Wales Australia; School of Public Health Imperial College London UK; Prasanna School of Public Health Manipal Academy of Higher Education Manipal India

A

Aletta E. Schutte

The George Institute for Global Health University of New South Wales Sydney New South Wales Australia; SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa; Hypertension in Africa Research Team (HART), MRC Unit for Hypertension and Cardiovascular Disease North‐West University Potchefstroom South Africa

B

Bolanle Banigbe

Boston University School of Public Health Boston Massachusetts USA; Resolve to Save Lives New York New York USA

D

Dorairaj Prabhakaran

Centre for Chronic Disease Control New Delhi India

A

Andrew E. Moran

Resolve to Save Lives New York New York USA; Columbia University Irving Medical Center New York New York USA

A

Abdul Salam

The George Institute for Global Health Hyderabad Telangana India; The George Institute for Global Health University of New South Wales Sydney New South Wales Australia; Prasanna School of Public Health Manipal Academy of Higher Education Manipal India

Funding

Wellcome Trust DBT India Alliance

Cite This Article

Gautam Satheesh, Rupasvi Dhurjati, Vivekanand Jha, et al. (2024). Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta‐Analysis of Randomized Clinical Trials. The Journal of Clinical Hypertension, 27(1). https://doi.org/10.1111/jch.14950

Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta‐Analysis of Randomized Clinical Trials

You May Also Like