Efficacy and cost-effectiveness of digital health interventions in improving hypertensive outcomes among patients with uncontrolled hypertension: A systematic review

Objectives: This systematic review aimed to identify effective and cost-effective digital health interventions to improve self-management behaviors, blood pressure control, and cardiovascular risk reduction. Methods: A search for randomized and non-randomized control trials of digital health interventions among patients with uncontrolled hypertension was conducted from the databases of Embase, PubMed, Scopus, CINAHL, Web of Science, PsycINFO, Thai Journal Online (ThaiJO), the Faculty of Nursing Mahidol University (FON-MU) Nursing Research Database, and gray literature. After conducting the literature screening, the authors completed data extraction, and the risk of bias was assessed using the Joanna Briggs Institute randomized controlled trial checklist and the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies. Results: The study included 22 articles, comprising 30 to 4,118 patients with uncontrolled hypertension. This review classified and summarized the components of digital health interventions and their effects on hypertensive outcomes. It was found that the key elements of digital health interventions include health education, reminders, self-monitoring, feedback and consultation, and instrumental support. Moreover, approximately 81.81 % (n = 18) of the digital health interventions involved healthcare providers participating in feedback and consultation. Additionally, digital health interventions effectively improve hypertensive outcomes such as self-management behaviors, blood pressure control, and cardiovascular risk reduction, providing cost-effectiveness. Conclusion: Based on the available literature, digital health interventions have been shown to effectively enhance behavioral, clinical, and economic outcomes for individuals with uncontrolled hypertension. Moreover, the combination of digital health interventions and healthcare providers' interventions can potentially help patients with uncontrolled hypertension improve adherence to self-management when compared to stand-alone digital health interventions. Digital health interventions to support self-management interventions should be developed for patients by healthcare providers. (c) 2025 The Authors. Published by Elsevier B.V. on behalf of the Chinese Nursing Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).