Table 3.
GRADE-pro summary table of IRT compared to control in the management of hypertension
| IRT compared to control in the management of hypertension | |||||
|---|---|---|---|---|---|
|
Patient or population: People with hypertension Intervention: IRT – Supervised and home-based Comparison: Control | |||||
| Outcomes | Anticipated absolute effects* (95%CI) |
№ of participants (studies) |
Certainty of the evidence (GRADE) |
Comments | |
| Risk with control | Risk with IRT | ||||
| Systolic blood pressure | Mean SBP ranged from 8 mmHg lower to 5 mmHg higher |
Mean SBP was on average 7.5 mmHg lower (95%CI -10.1 to -4.84 mmHg) |
415 (12 RCTs) |
⊕ ⊕ ⊕ ⊕ Higha |
SBP is lowered by 7.5 mmHg and cardiovascular event risk is reduced |
| Diastolic blood pressure | Mean DBP ranged from 8 mmHg lower to 3 mmHg higher |
Mean DBP was on average 3.2 mmHg lower (95%CI − 5.29 to − 1.04 mmHg) |
415 (12 RCTs) |
⊕ ⊕ ⊕ ⊕ Higha |
DBP is lowered by 3.2 mmHg and cardiovascular events risk is reduced |
| Mean arterial blood pressure | Mean MAP ranged from 4 mmHg lower to 3 mmHg higher |
Mean MAP was on average 7.2 mmHg lower (95%CI − 9.06 to − 5.32 mmHg) |
184 (7 RCTs) |
⊕ ⊕ ⊕ ⊝ Moderatea |
MAP is lowered by 7.2 mmHg and cardiovascular event risk may be reduced |
| Night-time systolic blood pressure | Night-time SBP ranged from 0.4 mmHg to 3 mmHg higher |
Mean night-time SBP was on average 4.3 mmHg lower (95%CI − 7.88 to − 0.67 mmHg) |
147 (4 RCTs) |
⊕ ⊕ ⊕ ⊝ Moderatea |
Night-time ambulatory SBP is lowered by 4.3 mmHg and cardiovascular risk and target organ damage may be reduced |
| Night-time diastolic blood pressure | Night-time DBP ranged from − 0.7 mmHg lower to 1.8 mmHg higher |
Mean night-time DBP was on average 2.2 mmHg lower (95%CI − 3.55 to − 0.88 mmHg) |
147 (4 RCTs) |
⊕ ⊕ ⊕ ⊝ Moderatea |
Night-time ambulatory DBP is lowered by 2.2 mmHg and cardiovascular risk and target organ damage may be reduced |
| *The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of IRT (and its 95%CI) | |||||
| CI: confidence interval; OR: odds ratio; RR: risk ratio | |||||
| GRADE Working Group grades of evidence | |||||
| High certainty: We are very confident that the true effect lies close to that of the estimate of the effect | |||||
| Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different | |||||
| Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect | |||||
| Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | |||||
aOne study used lower limb IRT. Ages were not given for some studies. Some studies used medicated participants; others were unmedicated
bAmbulatory blood pressure, as opposed to office measurements, is considered the gold standard method in some countries