Twenty-seven studies were included (n=5,995): 14 randomised controlled trials (RCTs) (n=3,566), including one of crossover design; and 13 non-randomised studies (n=2,429), including two experimental studies and 11 pre-post studies.
Health education (two RCTs, seven non-randomised studies, n=1,822): a crossover RCT of nutrition and exercise education reported significant reductions from baseline in systolic and diastolic BPs (SBP, DBP) in the intervention group (p<0.01 and p<0.05, respectively), with no significant changes among controls. A second RCT, in which the intervention included group dietary and exercise classes, SBP and DBP were lower in the intervention group than in controls at three- and six-month follow up. All but one of the seven non-randomised studies reported that the intervention was associated with statistically significant benefits in knowledge about hypertension and/or reduction in BP. Outcomes were reported either as changes from baseline or in comparison with controls.
Active self-management (six RCTs, four non-randomised studies, n=1,987): all studies reported that the intervention was associated with significant reductions in BP and/or improvements in control of BP. Outcomes were reported either as changes from baseline or in comparison with controls receiving usual care.
Social support in managing hypertension (three RCTs, n=817): two RCTs found significant benefits for the intervention group in control of BP, compared with usual/community care, at five years and three years. The third RCT reported no significant difference between the groups.
Community wide risk factor intervention (two RCTs, n=985): one RCT found significantly higher rates of BP control in the intervention group, compared with controls receiving enhanced primary care, at 12-month follow up. A second RCT found no significant difference between the groups when two levels of intensity of a community home worker intervention were compared; BP declined significantly in both groups.
No statistically significant findings were reported in studies of education and psychosocial counselling (two RCTs, n=327) or of individualised screening and risk factor reduction (one non-randomised study, n=57).
Strategies to achieve cultural sensitivity
Fifteen studies incorporated components of cultural sensitivity but none measured their effect on clinical outcomes.