Systematic Review/Meta-analysis
Reducing Blood Pressure With Internet-Based Interventions: A Meta-analysis

https://doi.org/10.1016/j.cjca.2013.02.007Get rights and content

Abstract

Background

Elevated blood pressure is a leading risk factor for cardiovascular disease and mortality. Internet-based interventions (e-counselling) have the potential to deliver a wide range of preventive counselling services. The purpose of this review was to (1) assess the efficacy of e-counselling in reducing blood pressure and (2) identify key components of successful trials in order to highlight factors that may contribute significantly to blood pressure control.

Methods

MEDLINE, PubMed, EMBASE, PsycINFO, and the Cochrane Library were searched up to June 2012 with the following key words: Web-based, Internet-based, e-counselling, mobile health, blood pressure, and hypertension. Trials were selected in which blood pressure was reported as a primary or secondary outcome and whose participants had baseline systolic and diastolic blood pressure within the prehypertensive (120-139/80-89 mm Hg) or hypertensive (≥ 140/90 mm Hg) range.

Results

The search strategy identified 13 trials, and the mean reduction of systolic and diastolic blood pressure was −3.8 mm Hg (95% confidence interval [Cl], −5.63 to −2.06 mm Hg; P < 0.01) and −2.1 mm Hg (95% CI, −3.51 to −0.65 mm Hg; P < 0.05), respectively. The greatest magnitude of blood pressure reduction was found for interventions that lasted 6 months or longer, used 5 or more behavior change techniques, or delivered health messages proactively.

Conclusion

Research on preventive e-counselling for blood pressure reduction is at an early stage of development. This review provides preliminary evidence of blood pressure reduction with Internet-based interventions. Future studies need to evaluate the contribution of specific intervention components in order to establish a best practice e-counselling protocol that is efficacious in reducing blood pressure.

Résumé

Introduction

L'hypertension artérielle est l'un des principaux facteurs de risque de maladie cardiovasculaire et de mortalité. Les interventions par Internet (counseling en ligne) ont le potentiel d'offrir une vaste panoplie de services en counseling préventif. Le but de cette revue était : 1) d'évaluer l'efficacité du counseling en ligne en ce qui a trait à la diminution de la pression artérielle; 2) de déterminer les composantes clés d'essais réussis pour souligner les facteurs qui peuvent contribuer de manière significative à la maîtrise de la pression artérielle.

Méthodes

Les bases de données MEDLINE, PubMed, EMBASE, PsycINFO et la Bibliothèque Cochrane ont été examinées jusqu'en juin 2012 à l'aide des mots clés suivants : sur le Web, sur Internet, counseling en ligne, santé mobile, pression artérielle et hypertension. Les essais ont été sélectionnés parmi ceux dont la pression artérielle était rapportée comme un critère de jugement primaire ou secondaire, et chez les participants qui avaient au départ une pression artérielle systolique et diastolique dans la fourchette de préhypertension (120-139/80-89 mm Hg) ou d'hypertension (≥ 140/90 mm Hg).

Résultats

La stratégie de recherche a relevé 13 essais dans lesquels la diminution moyenne de la pression artérielle systolique et diastolique était respectivement de −3,8 mm Hg (intervalle de confiance [IC] à 95 %, −5,63 à −2,06 mm Hg; P < 0,01) et de −2,1 mm Hg (IC à 95 %, −3,51 à −0,65 mm Hg; P < 0,05). La plus importante diminution de pression artérielle a été observée suite aux interventions qui ont duré plus de 6 mois, qui ont utilisé 5 méthodes de changement de comportement ou plus ou lorsque les informations relatives à la santé ont été transmises proactivement.

Conclusion

La recherche sur le counseling préventif en ligne pour la diminution de la pression artérielle est à un stade précoce de développement. Cette revue fournit des données scientifiques préliminaires sur la diminution de la pression artérielle par des interventions par Internet. Des études subséquentes doivent comparer la contribution des composantes spécifiques d'intervention pour établir un meilleur protocole de pratique du counseling en ligne qui est efficace dans la diminution de la pression artérielle.

Section snippets

Methods

This meta-analysis was based on guidelines from the Cochrane Handbook for Systematic Reviews of Interventions.13 Reporting of results followed the Preferred Items of Systematic Reviews and Meta-Analyses guidelines.14

Article selection

A total of 908 studies were identified within our database search. After reviewing the abstract and removing duplicate publications, 54 full-text articles were reviewed. Out of these articles, 13 met the inclusion criteria (Fig. 1).

Study characteristics

Six of the studies were conducted in the United States, 3 in South Korea, 2 in Canada, 1 in Australia, and 1 in Germany. There were a total of 11 randomized control trials and 2 studies that matched controls by age, sex, body weight, and blood pressure. See

Discussion

The primary aim of the present meta-analysis was to evaluate the effectiveness of Internet-based interventions in reducing blood pressure in individuals with prehypertension or hypertension. We found that Internet-based interventions significantly reduced SBP by 3.8 mm Hg and DBP by 2.1 mm Hg. It is noteworthy that this change in SBP was comparable to the magnitude of blood pressure reduction reported in previous meta-analyses of face-to-face lifestyle counselling.3, 4 A reduction in SBP of 3

Conclusion

There is preliminary evidence supporting the efficacy of e-counselling as a complementary intervention for managing blood pressure. We found that Internet-based interventions may be more efficacious when a program lasts 6 months or longer, is delivered proactively, and provides at least 5 behaviour change techniques. In order to build an evidence-based guideline for preventive e-counselling, there is an immediate need to design trials that provide a direct comparison of specific intervention

Funding Sources

S. Liu was supported by the Ontario Student Opportunity Trust Fund.

Disclosures

The authors have no potential conflicts of interest.

References (40)

  • A. Pressler et al.

    An Internet-delivered exercise intervention for workplace health promotion in overweight sedentary employees: a randomized trial

    Prev Med

    (2010)
  • M. Park et al.

    Evaluation of mobile phone and Internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesity

    Int J Med Inform

    (2012)
  • S.P. Whelton et al.

    Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials

    Ann Intern Med

    (2002)
  • H.O. Dickinson et al.

    Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials

    J Hypertens

    (2006)
  • Statistics Canada. Canadian Internet use survey: 2010. Available at:...
  • F. Griffiths et al.

    Why are health care interventions delivered over the Internet? A systematic review of the published literature

    J Med Internet Res

    (2006)
  • L. Neubeck et al.

    Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review

    Eur J Cardiovasc Prev Rehabil

    (2009)
  • J. Gabriele et al.

    Directive and nondirective e-coach support for weight loss in overweight adults

    Ann Behav Med

    (2011)
  • T.L. Webb et al.

    Using the Internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy

    J Med Internet Res

    (2010)
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