Table 1 Summary of findings on non-pharmacological interventions for the treatment of hypertension in primary care
Type of intervention | Common implementation strategies in primary care | Key findings on effectiveness, barriers, and facilitators |
|---|---|---|
Alcohol intake reduction | 1. Brief alcohol intervention | Effectiveness Average reduction in alcohol intake: 26 g/week (95% CI: ‐37, ‐14) [40] Rose et al. [54] found a reduction of 4.2 mmHg in systolic blood pressure and 3.3 mmHg in diastolic blood pressure among hypertensive patients who received a brief alcohol intervention Cost-effectiveness The incremental cost-effectiveness ratio of implementing a brief alcohol intervention for alcohol reduction in primary care was found to be at least AU$650 per QALY/life-year gain [45] Barriers Existing workload, limited resources and support, and perceived lack of knowledge and confidence among providers [48] Facilitators Adequate resources, availability of training for providers, and tailoring interventions to patient needs [48] |
Salt intake reduction | 1. Dietary counselling | Effectiveness Dietary counselling led to average reduction in sodium intake of 73 to 93 mmol/day across the intervention groups vs. 3.2 to 12.5 mmol/day among controls. An average reduction in blood pressure was -4 to -27 mmHg [55] Cost-effectiveness No published evidence found Barriers Poor adherence to low-salt diet among patients [56], low self-efficacy among patients [57], difficulties associated with monitoring salt intake in primary care [58], perceived lack of time among primary care workers, and lack of reimbursement for providing the service [36] Facilitators No published evidence found |
Potassium intake | 1. Advice to increase intake of potassium-rich fruit and vegetables 2. Advice to use potassium-containing supplements | Effectiveness Findings on the effect of advice-based interventions promoting potassium rich fruit and vegetables intake on blood pressure in primary care settings are inconsistent [59,60,61] No published evidence was found about the effect of potassium supplementation on blood pressure in primary care settings. However, a systematic review found that potassium supplementation decreases systolic blood pressure on average by 4.48 mmHg in hypertension [62] The study did not specify the study setting(s) Cost-effectiveness No published evidence found Barriers Low patient motivation, lack of provider time, and lack of educational resources for patients Facilitators No published evidence found |
Physical activity | 1. Brief Intervention 2. Exercise referral schemes | Effectiveness Brief intervention resulted in a small increase in physical activity (standardized mean difference of 0.17) [63] Exercise referral schemes resulted in an increase in physical activity of on average 55 min per week [64] Cost-effectiveness The incremental cost per QALY of Brief Intervention is AU$ 3160 [65] Exercise referral led to an increase of 0.003 quality-adjusted life-years (QALYs) at an additional cost of AU$ 458 per person, typically per 10–12 weeks of intervention [64] Barriers Lack of time, limited resources, and lack of financial incentives for healthcare workers [63, 66] Lack of professional guidance when learning how to exercise and while exercising, lack of peer support, lack of family and social support, and lack of motivation for patients [63, 66, 67] Facilitators Health workers’ perception of physical activity as an effective intervention, and financial incentives for healthcare workers [63, 66, 67] |
Weight reduction | 1. Behavioural therapy 2. Restrictive diet | Effectiveness Behavioural therapy led to an average weight reduction of 1.4 kg [68] Compared with a behavioural programme alone, very low energy diet combined with a behavioural programme reduced weight by 3.9 kg at one year, 1.4 kg at two years, and 1.3 kg at 38–60 months [69] Cost-effectiveness No published study was found on cost-effectivenss analysis. However, a study reported the cost of behavioural therapy as AU$ 170 per one kilogram of weight lost [70] The incremental cost-effectiveness ratio of low energy dietary replacement was AU$ 5882 (4738–7060), assuming that the weight reduced by one kilo is maintained for at least 5 years [71] Barriers Lack of self-motivation, lack of self-control, inability to afford healthy foods and exercise equipment, inability to resist the temptation to eat ‘junk’ food, competing priorities, and comorbidities in patients [72, 73]. Reluctance to discuss weight management with patients, insufficient confidence, knowledge and skill to help patients manage their weight, lack of clear guidelines for weight management in primary care, and limited resources and time among health professionals [73, 74] Facilitators Peer support, professional support, social support, self-motivation to adhere to the dietary intervention, incentives and rewards are facilitators found for patients [73, 74] |
Heart-healthy diets | Dietary counselling | Effectiveness Inconsistent findings on the effectiveness of diets for blood pressure reduction in primary care settings Cost effectiveness No published evidence found Barriers Low patient motivation, lack of provider time, lack of educational resources for patients [75], difficulty in assessing patient’s dietary pattern, patient’s non-adherence to dietary advice, inconsistent dietary guidelines [76] Facilitators Facilitators for physician-delivered dietary advice for patients with hypertension are using electronic medical record tools that support dietary screening or counselling, access to dietitian support, and availability of educational resources for physicians |