Digital Health Interventions Can Reduce Hypertension Among Disadvantaged Populations

Patients from disadvantaged populations who underwent digital health interventions for management of hypertension experienced significant reductions in blood pressure (BP), according to a systematic review and meta-analysis of studies published in the Journal of the American Medical Association.

Digital health technology has emerged as a promising pathway for managing hypertension, especially in underserved populations impacted by barriers to accessing care, the investigators wrote.

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The study aimed to analyze the association between digital health interventions and changes in BP among populations who experience health disparities, as well as to characterize contemporary strategies that can help meet the needs of populations who experience these disparities.

In their search of literature, 308 full-text articles were evaluated, with 28 studies and 1 cohort study ultimately included in the analysis. There were 8257 individuals included in the review, with 3828 (46.4%) assigned to an intervention group and 4429 (53.6%) assigned to a standard treatment control group.

The mean (SD) systolic BP (SBP) at baseline for the digital health intervention and control groups was 138.6 (16.3) mm Hg and 139.2 (16.2) mm Hg respectively. At follow-up, the mean SBP was 131.8 (15.9) mm Hg in the intervention groups and 135.3 (16.5) mm Hg in the control groups, the investigators found.

Regarding diastolic BP (DBP), the mean (SD) DBP at baseline for the digital health intervention and control groups was 81.4 (11.8) mm hg and 81.7 (11.7) mm Hg respectively. The mean follow-up DBP at the end of the included studies was 77.8 (10.5) mm Hg in the digital health intervention groups and 79.6 (11.2) mm Hg in the control groups, according to the investigators.

Individuals who received a digital health intervention had a 4.24 mm Hg greater reduction in SBP compared with those in a control group at 6 months follow-up, which follows the overall trend found in the rest of the studies in the review and with other systematic reviews on the topic.

The investigators had few concerns regarding the quality of the studies included in the systematic review; 8 of the 28 studies (28.6%) had some concerns of bias, but these were mostly attributed to missing outcome data.

To the investigators' knowledge, this was the first large-scale, contemporary analysis of thousands of participants to analyze existing evidence on outcomes of digital health interventions for hypertension management in populations with health disparities. They noted that the study strengthens the case for digital interventions as an effective tool for managing hypertension in these populations.

Cardiovascular disease and hypertension have been increasingly linked to health disparities through an increasing number of studies. Several of the studies included in the review directly addressed the challenges that disadvantaged populations face, the investigators wrote.

A range of diverse recruitment strategies and culturally tailored interventions were observed. These included adherence reminders that were linguistically tailored to a patient population and faith-based community partnerships. Notably, community-based interventions eased the stressors associated with clinical settings, the authors noted.

Investigators noted that the study was limited in its ability to analyze patient-level data on BP beyond 1 year. Additionally, their literature search may not have captured all possible studies on specific subpopulations experiencing disparities.

“With the increased use of digital health technologies in medicine, it is important that researchers, clinicians, and public health professionals continue to adapt digital health interventions to meet the needs of demographically and socioeconomically diverse populations with different challenges to improving BP control,” the investigators concluded.

Reference

Katz ME, Mszar R, Grimshaw AA, et al. Digital health interventions for hypertension management in US populations experiencing health disparities: asystematic review and meta-analysis. JAMA Netw Open. 2024;7(2):e2356070. doi:10.1001/jamanetworkopen.2023.56070