Dataset Information

Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol.

ABSTRACT:

Background

Hypertension is one of the public health challenges. Various risk factors are associated with hypertension, including social demographics, geographical location, health behaviours, and social stress. Interventions in the social determinants of health can improve hypertension and health promotion. Accordingly, different sectors such as agriculture, housing, education, and transportation should cooperate. This systematic review examines policies as a set of activities and actions/interventions aimed at the modification of the social determinants of health to prevent hypertension.

Methods

A systematic search will be conducted in Medline (via Ovid), PubMed, EMBASE, Cochrane Library, ProQuest Dissertations & Theses, and scientific Persian databases including SID and Magiran. There will be no time restriction. The quality of selected studies will be assessed using an appropriate Joanna Briggs Institute (JBI) Critical Appraisal Checklists according to the type of studies. Two independent researchers will carry out screening and quality assessment. Disagreement between two researchers will be resolved by a third party.

Discussion

Recommendations will be made for policymakers in order to make better evidence-based decisions about the prevention and management of hypertension with regard to the social determinants of health.

Systematic review registration

PROSPERO CRD42020152298.

SUBMITTER: Arabi Basharic F

PROVIDER: S-EPMC7315529 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol.

Arabi Basharic Fateme F Janati Ali A Pezeshki Mohammad Zakaria MZ Khodayari-Zarnaq Rahim R Sadeghi-Ghyassi Fatemeh F Gholizadeh Masoumeh M

Systematic reviews 20200624 1

<h4>Background</h4>Hypertension is one of the public health challenges. Various risk factors are associated with hypertension, including social demographics, geographical location, health behaviours, and social stress. Interventions in the social determinants of health can improve hypertension and health promotion. Accordingly, different sectors such as agriculture, housing, education, and transportation should cooperate. This systematic review examines policies as a set of activities and action ...[more]

PMID: 32580747

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Project description:Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Clinical Trials NCT00970931.

Project description:BackgroundDigital interventions, defined as any intervention accessed and taking input from patients in the form of a computer/Web-based program or mobile phoned-based app, can potentially help empower patients to self-manage long-term conditions such as hypertension. Importantly, digital interventions have the potential to provide patients with personalized information and support for active involvement in treatment as well as cost saving.ObjectiveThe purpose of this systematic review is to synthesize the evidence for using digital interventions to support patient self-management of hypertension, and determine their impact on control and reduction of blood pressure, other clinical outcomes, quality of life, medication adherence, health service utilization, and economic benefits.MethodsA systematic search of bibliographic databases including Medline, Embase, CINAHL, and PsycINFO will be undertaken. Abstracts and citations will be independently screened by 2 researchers against predetermined inclusion criteria. Any disagreements will be resolved by discussion and further consideration of the inclusion criteria. Only randomized controlled trials which have been published in peer peer-reviewed journals with a diagnosis of hypertension will be considered. Inclusion criteria will be (1) adults (age ≥ 18 years) with hypertension (as defined by the primary authors); (2) an interactive digital intervention compared with usual care; and (3) outcomes of objectively measured change in blood pressure. Data extraction from identified articles will be undertaken by 2 independent reviewers using a uniform template. The main outcomes are systolic blood pressure (SBP) and diastolic blood pressure (DBP), and quality of life indicators. Secondary outcomes include cost- effectiveness, medication adherence, emotional well-being, and physical activity. Risk of bias of included studies will be assessed using the Cochrane tool.ResultsOur research is currently ongoing. Data will be summarized narratively, and if possible, meta-analyses will be performed to assess the impact of the interventions on outcomes.ConclusionsBy summarizing and synthesizing available data, this review will help inform policy on the use of digital interventions for self-management of hypertension and will clarify areas for further research.Trial registrationProspero 2014: CRD42014010268; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42014010268 (Archived by WebCite at http://www.webcitation.org/6c5alQQJL).

Project description:BACKGROUND:Stroke secondary prevention guidelines recommend medication prescription and adherence, active education and behavioural counselling regarding lifestyle risk factors. To impact on recurrent vascular events, positive behaviour/s must be adopted and sustained as a lifestyle choice, requiring theoretically informed behaviour change and self-management interventions. A growing number of systematic reviews have addressed complex interventions in stroke secondary prevention. Differing terminology, inclusion criteria and overlap of studies between reviews makes the mechanism/s that affect positive change difficult to identify or replicate clinically. Adopting a two-phase approach, this overview will firstly comprehensively summarise systematic reviews in this area and secondly identify and synthesise primary studies in these reviews which provide person-centred, theoretically informed interventions for stroke secondary prevention. METHODS:An overview of reviews will be conducted using a systematic search strategy across the Cochrane Database of Systematic Reviews, PubMed and Epistomonikas. INCLUSION CRITERIA:systematic reviews where the population comprises individuals post-stroke or TIA and where data relating to person-centred risk reduction are synthesised for evidence of efficacy when compared to standard care or no intervention. Primary outcomes of interest include mortality, recurrent stroke and other cardiovascular events. In phase 1, two reviewers will independently (1) assess the eligibility of identified reviews for inclusion; (2) rate the quality of included reviews using the ROBIS tool; (3) identify unique primary studies and overlap between reviews; (4) summarise the published evidence supporting person-centred behavioural change and self-management interventions in stroke secondary prevention and (5) identify evidence gaps in this field. In phase 2, two independent reviewers will (1) examine person-centred, primary studies in each review using the Template for Intervention Description and Replication (TIDieR checklist), itemising, where present, theoretical frameworks underpinning interventions; (2) group studies employing theoretically informed interventions by the intervention delivered and by the outcomes reported (3) apply GRADE quality of evidence for each intervention by outcome/s identified from theoretically informed primary studies. Disagreement between reviewers at each process stage will be discussed and a third reviewer consulted. DISCUSSION:This overview will comprehensively bring together the best available evidence supporting person-centred, stroke secondary prevention strategies in an accessible format, identifying current knowledge gaps.

Dataset Information

Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol.

Background

Methods

Discussion

Systematic review registration

Publications

Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol.

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