Effectiveness of multiple combined lifestyle interventions in reducing blood pressure among patients with prehypertension and hypertension: a network meta-analysis.

BACKGROUND:Different combinations of lifestyle interventions have been studied with varying results on hypertension control. Hence, this review was done to compare multiple combined lifestyle intervention in reducing blood pressure (BP) among patients with prehypertension or hypertension. METHODS:We conducted systematic search in the following databases: MEDLINE, PubMed Central, CENTRAL, ScienceDirect, Google Scholar from 1964 until November 2020. Estimates of comparative intervention effect from network meta-analyses (random-effects model) were represented as mean difference (MD) with 95% confidence interval. RESULTS:In total, 14 studies with 2451 participants were included. Almost all the studies had high risk of bias. Healthy diet (HD) and physical activity (PA) combination showed highest mean reduction in systolic BP (-9.88 mmHg) and diastolic BP (-6.28 mmHg) followed by HD + PA + smoking cessation + alcohol restriction combination (systolic BP = -6.58 mmHg, diastolic BP = -4.09 mmHg) compared with usual care. HD and PA combination had the highest probability of being the best intervention (82.8% for SBP and 81.7% for DBP). CONCLUSION:We found that HD and PA are the most important combination of lifestyle modifications for prehypertensive and hypertensive patients. Hence, a coordinated approach is required from the clinicians by integrating beneficial effect of these modifications through education, counselling and support. SUMMARY BOX: