Cardiac eHealth and Behavioural Cardiology Research Unit, University Health Network (UHN), Toronto, Ontario, Canada; Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Cardiac eHealth and Behavioural Cardiology Research Unit, University Health Network (UHN), Toronto, Ontario, Canada.
Can J Cardiol. 2020 May;36(5):764-774. doi: 10.1016/j.cjca.2019.11.010. Epub 2019 Nov 15.
Behavioural counselling via internet- or mobile-based digital platforms is recommended for hypertension; however, outcome heterogeneity is problematic in trials of this digital intervention. Our objective was to assess how therapeutic outcome was optimized in digital trials for hypertension, according to key features of the intervention design and protocol.
We identified randomized controlled digital trials for systolic blood pressure (SBP) reduction in taskforce guideline and policy statements, systematic reviews, and meta-analyses published since 2010, by searching the EMBASE, Cochrane Library, psycINFO, and PubMed databases. This search was updated to January 2019. Trials included patients with elevated cardiovascular risk or cardiovascular disease. We classified digital trials by the number of components of the intervention, and whether the protocol was organized by an explicit model of behavioural change or counselling. The influence of these features was evaluated for treatment efficacy and heterogeneity of SBP outcomes.
Seventeen trials met inclusion criteria: pooled n = 5780, 33% female, 93% taking antihypertensive medications. SBP reduction was -7.3 mm Hg for digital counselling (95% confidence interval: -7.0 to -7.5) vs -3.6 mm Hg for control (95% confidence interval: -3.4 to -3.9), P < 0.0001, with high-moderate heterogeneity (I = 67%). Trials with multiple behavioural intervention components and an organized theoretical framework of behaviour change or counselling demonstrated optimal SBP reduction with low-moderate heterogeneity (I = 49%).
Digital health interventions optimize the efficacy of medical therapy for SBP reduction. There is opportunity to promote a disruptive change in clinical science that accompanies technological developments in digital health promotion.
行为咨询通过互联网或移动数字平台推荐用于高血压；然而，这种数字干预试验的结果存在异质性问题。我们的目的是根据干预设计和方案的关键特征，评估数字高血压试验中治疗结果是如何得到优化的。
我们在任务组指南和政策声明、系统评价和荟萃分析中确定了自 2010 年以来发表的针对收缩压（SBP）降低的随机对照数字试验，通过搜索 EMBASE、Cochrane 图书馆、psycINFO 和 PubMed 数据库。该搜索更新至 2019 年 1 月。试验纳入了心血管风险升高或患有心血管疾病的患者。我们根据干预措施的组成部分数量以及方案是否按照行为改变或咨询的明确模型组织对数字试验进行分类。评估了这些特征对治疗效果和 SBP 结果异质性的影响。
17 项试验符合纳入标准：汇总 n = 5780 例，33%为女性，93%服用抗高血压药物。数字咨询的 SBP 降低为-7.3mmHg（95%置信区间：-7.0 至-7.5），而对照组为-3.6mmHg（95%置信区间：-3.4 至-3.9），P < 0.0001，具有高度异质性（I = 67%）。具有多个行为干预组件和行为变化或咨询的有组织理论框架的试验显示出 SBP 降低的最佳效果，异质性低（I = 49%）。
数字健康干预措施优化了医学治疗对 SBP 降低的效果。有机会在数字健康促进的技术发展的同时促进临床科学的颠覆性变革。
