Systolic Blood Pressure Control in Nepal: A Systematic Review and Meta-analysis of Interventional Studies

Objective: To determine the effectiveness of health education and community-based interventions in reducing systolic blood pressure (SBP) among hypertensive individuals in Nepal through a systematic review and meta-analysis. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs) using a random-effects model, conducted in accordance with PRISMA guidelines. Study Selection: Eight RCTs conducted in Nepal were selected based on predefined inclusion criteria. Eligible studies included adult hypertensive participants and assessed interventions such as health education sessions, community-based counseling, mobile health (mHealth) messages, pharmacist-led care, and lifestyle modifications, with SBP as an outcome. Data Extraction and Synthesis Two reviewers independently extracted data on study characteristics, intervention types, and SBP outcomes. Standardized mean differences (SMDs) were calculated. Heterogeneity was assessed using I² and Q statistics. Subgroup, outlier, risk of bias analyses were conducted. Publication bias was examined using Egger’s and Begg’s tests. Certainty of evidence was evaluated using the GRADE framework. Main Outcome Measures Change in systolic blood pressure (SBP) from baseline to follow-up. Results: The pooled analysis showed a statistically significant reduction in SBP (SMD = − 0.17; 95% CI: −0.29 to − 0.05; p  = 0.005). Both health worker-led and Female Community Health Volunteer (FCHV)-led interventions were effective. Moderate heterogeneity was observed (I² = 48.79%), and one study (Bhattarai et al., 2024) was identified as an outlier. Egger’s test indicated potential publication bias ( p  = 0.001). The overall certainty of evidence was rated as very low due to serious risk of bias, inconsistency, and suspected publication bias. Conclusion: Health education and community-based interventions show modest but meaningful effects on blood pressure control in Nepal. Community-led models, particularly FCHV-based approaches, offer promising, scalable solutions. However, findings should be interpreted with caution, and further high-quality research is needed to confirm and expand these results. PROSPERO registration: CRD42025643469