The effectiveness of the chronic disease management for hypertension: A systematic review and meta-analysis.

BACKGROUND

Chronic disease management (CDM) is becoming more crucial in optimizing the management of hypertension and related risk control while enhancing the self-efficacy of patients. However, there is a lack of systematic summaries on the subject. This study aimed to provide synthesized evidence on the effectiveness of interventions and the quality of evidence for the implementation of CDM for hypertension.

METHODS

The protocol of this study was registered on PROSPERO (CRD42023472066). Traditional (randomized control trial)/cluster randomized controlled trials were searched on Medical Literature Analysis and Retrieval System Online (database) (via PubMed), Excerpta Medica dataBASE, and Cochrane from inception until September 30th, 2023 (updated to March 31st, 2025), including comparisons of CDM with blank control/usual care (BC/UC), or comprehensive CDM with only self-management support (SMS). We applied data pooling using a fixed/random effect model to account for statistical heterogeneity. Effect sizes for continuous and categorical outcomes were expressed as mean difference (MD) or standardized MD (SMD), and risk ratios with 95% confidence intervals (CIs).

RESULTS

We included 10 randomized control trials and 6 cluster randomized controlled trials enrolling 9109 patients for systematic review and meta-analysis. Compared with BC/UC, CDM was more conducive to diastolic blood pressure control after 3 to 4 months (MD with 95% CI -6.46 [-8.23, -4.69], moderate certainty). Comprehensive CDM was better for cardiovascular disease risk control than BC or only SMS after 6 months (SMD with 95% CI -1.82 [-3.06, -0.58], moderate certainty). Concerning self-efficacy improvement, comprehensive CDM was more beneficial than BC/UC (SMD with 95% CI 0.73 [0.45, 1.01] and 1.01 [0.72, 1.30] after 6 weeks and 3 months, moderate certainty).

CONCLUSION

In summary, CDM improved hypertension control especially diastolic blood pressure after a 3-month follow-up, and comprehensive CDM instead of only SMS favored cardiovascular disease risk control after a 6-month follow-up. The evidence remains to be strengthened via further large-scale, targeted verification, and to be systematically accumulated to provide a basis for network comparisons among CDM models.