Li Zeyu, Wu Jiahua, Yuan Weidan, Lan Danchun, Chang Ruchun, Li Ziyong, Lu Liming, Zhang Peiming
Gaozhou Traditional Chinese Medicine Hospital, Maoming, China.
Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine (The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine), Chancheng District, Foshan, China.
Medicine (Baltimore). 2025 Jul 25;104(30):e42455. doi: 10.1097/MD.0000000000042455.
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.
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).
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).
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.
慢性病管理（CDM）在优化高血压管理及相关风险控制、提高患者自我效能方面愈发关键。然而，目前缺乏关于该主题的系统综述。本研究旨在提供CDM干预措施有效性的综合证据以及实施高血压CDM的证据质量。
本研究方案已在国际前瞻性注册系统（PROSPERO，注册号：CRD42023472066）上注册。通过医学文献分析和检索系统在线数据库（MEDLINE，通过PubMed）、荷兰医学文摘数据库（EMBASE）以及考克兰系统评价数据库，检索自建库起至2023年9月30日（更新至2025年3月31日）的传统（随机对照试验）/整群随机对照试验，包括CDM与空白对照/常规护理（BC/UC）的比较，或综合CDM与仅自我管理支持（SMS）的比较。我们采用固定/随机效应模型进行数据合并，以处理统计异质性。连续和分类结局的效应量分别表示为平均差（MD）或标准化平均差（SMD），以及95%置信区间（CI）的风险比。
我们纳入了10项随机对照试验和6项整群随机对照试验，共9109例患者进行系统评价和荟萃分析。与BC/UC相比，CDM在3至4个月后更有利于舒张压控制（MD，95%CI为-6.46[-8.23，-4.69]，中等确定性）。6个月后，综合CDM在心血管疾病风险控制方面优于BC或仅SMS（SMD，95%CI为-1.82[-3.06，-0.58]，中等确定性）。在自我效能改善方面，综合CDM比BC/UC更有益（6周和3个月后的SMD，95%CI分别为0.73[0.45，1.01]和1.01[0.72，1.30]，中等确定性）。
综上所述，CDM改善了高血压控制，尤其是3个月随访后的舒张压，6个月随访后，综合CDM而非仅SMS更有利于心血管疾病风险控制。仍需通过进一步大规模、针对性验证来加强证据，并进行系统积累，为CDM模型间的网络比较提供依据。
