Open Access Research article

Effectiveness of interventions for hypertension care in the community – a meta-analysis of controlled studies in China

Zuxun Lu1, Shiyi Cao1, Yun Chai2, Yuan Liang1, Max Bachmann3, Marc Suhrcke34 and Fujian Song3*

Author Affiliations

1 Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China

2 Centre of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China

3 Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, Norfolk, UK

4 UKCRC Centre for Diet and Activity Research (CEDAR), Cambridge, UK

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BMC Health Services Research 2012, 12:216  doi:10.1186/1472-6963-12-216

Published: 24 July 2012

Abstract

Background

Hypertension is a serious public health problem in China and in other developing countries. Our aim is to conduct a systematic review of studies on the effectiveness of community interventions for hypertension management in China.

Methods

China National Knowledge Infrastructure, PubMed, and references of retrieved articles were searched to identify randomised or quasi-randomised controlled studies that evaluated community hypertension care in mainland China. One reviewer extracted and a second reviewer checked data from the included studies.

Results

We included 94 studies, 93 of which were in Chinese language, that evaluated the following interventions: health education, improved monitoring, family-support, self-management, healthcare management changes and training of providers. The study quality was generally poor, with high risk of biased outcome reporting and significant heterogeneity between studies. When reported, the vast majority of the included studies reported statistically significantly improved outcomes in the intervention group. By assuming zero treatment effects for missing outcomes, the weighted reduction in the intervention group was 6∙9 (95% CI: 4∙9 to 8∙9) mm Hg for systolic BP, and 3∙8 (95% CI: 2∙6 to 5∙0) mm Hg for diastolic BP. Exploratory subgroup analyses found no significant differences between different interventions.

Conclusions

After taking account of possible reporting biases, a wide range of community interventions for hypertension care remain effective. The findings have implications for China and other low and middle income countries facing similar challenges. Because of significant heterogeneity and high risk of bias in the available studies, further well designed studies should be conducted in China to provide high quality evidence to inform policy decisions on hypertension control.

Keywords:
Hypertension; Quality of hypertension care; Community-based interventions; Primary care; Low and middle income countries; Systematic review