Twenty studies (29,509 participants) were included: 6 RCTs, 3 controlled studies and 11 before-and-after studies. There were 4 RCTs on hypertension (1,734 participants) and two on hyperlipidaemia-CAD (4,469 participants); 2 controlled studies on hypertension (4,482 participants) and one on hyperlipidaemia-CAD (325 participants); and 5 before-and-after studies on CHF (2,078 participants) and three each on hypertension (638 participants) and hyperlipidaemia-CAD (15,783 participants).
Five before-and-after studies assessed programmes for CHF. All showed benefits of the intervention: three showed improvements in hospital admission rates, length of stay or health care utilisation; two showed increased use of appropriate medication; and two showed improvements in functional status or clinical outcomes.
Three RCTs reported benefits in the treatment groups in comparison with the control groups (variously: improvements in BP, lower hospital service utilisation, improved rates of follow-up visits and higher medication compliance).
Of the 2 controlled studies, one reported a benefit with treatment in increased appropriate drug use whilst the other reported no substantive gain in outcomes of BP control.
Of the 3 before-and-after design studies, one reported benefits in achieving BP goals but no differences in lifestyle modifications, although there was some improvement in quality-of-life outcomes; a second reported significant decreases in BP associated with improvements in lifestyle modifications; the third did not report the outcomes clearly.
One RCT reported little difference in changes in total cholesterol in the treatment and control groups. The second reported greater benefits in changes in cholesterol in the intervention group, although this study was limited to people hospitalised for acute myocardial infarction.
The controlled study showed no improvement in dietary knowledge after the intervention, but did not report on levels of cholesterol or clinical outcomes.
Three before-and-after studies showed improvements in risk factors, with an increase in the achievement of low-density lipoprotein cholesterol goals with the intervention.