A systematic review 1 including 62 studies was abstracted in DARE. Eleven studies (4 RCTs) and 7 quasi-experimental trials were on screening interventions, 5 trials were on interventions to improve adherence to treatment with only adherence outcomes, 19 RCTs examined different methods of improving adherence, 5 RCTs measured home monitoring of blood pressure, 13 RCTs examined patient education interventions aimed at improving blood pressure control, 4 RCTs examined professional education interventions aimed at improving blood pressure control, and 5 examined miscellaneous methods to improve blood pressure control.
Detection. Population screening compared with usual care or case finding does not appear to increase coverage of the population assessed for hypertension or detection of hypertension. Case finding appears to be particularly effective when linked with professional training, protocols, and reminders to record blood pressure given to both patients and doctors. Ambulatory monitoring does not have a role in the detection of hypertension in the population.
Patient adherence. No single approach to adherence can be recommended based on the evidence reviewed. Complex interventions involving education, easier access to care, and use of protocols may improve adherence and control in some patients.
Blood pressure control. A comprehensive "stepped care" approach (education, free care, specialist clinics, and protocols) achieves the greatest improvements in control. Self-monitoring of blood pressure at home appears to have a small but significant effect on blood pressure control. Locally, rather than expert, produced guidelines that are integrated into clinical practice improve both practice and clinical outcomes.
Comment: The quality of evidence is downgraded by potential reporting bias (only MEDLINE was searched).
The following decision support rules contain links to this evidence summary:
Primary/Secondary Keywords