Abstract

Background: Hypertension remains a major global risk factor for cardiovascular disease, yet blood pressure (BP) control rates are suboptimal. Self-management, telemonitoring, and combined multicomponent interventions have emerged as promising strategies, but their relative effectiveness and mechanisms require synthesis. Objective: This systematic review compared the effectiveness of self-management, telemonitoring, and multicomponent interventions on BP control in adults with hypertension and explored their behavioral and clinical mechanisms. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, CINAHL, ScienceDirect, and ProQuest were searched from inception to December 2025. Eligible studies were randomized controlled trials and quasi-experimental studies evaluating self-management, telemonitoring, or combined interventions in hypertensive adults. Primary outcome was systolic blood pressure (SBP). Methodological quality and risk of bias were assessed using JBI tools, RoB 2, and ROBINS-I. Narrative synthesis with visual summaries was conducted due to heterogeneity. Results: Nineteen studies (16 RCTs, 3 quasi-experimental; total participants ≈5,000) were included. Self-management interventions (n=11) consistently improved behavioral outcomes (adherence, self-efficacy, self-care) with variable SBP reductions. Telemonitoring interventions (n=4) showed more consistent and clinically meaningful SBP reductions through enhanced clinical feedback. Combined multicomponent interventions (n=4), integrating self-monitoring, behavioral support, and treatment adjustment, produced the largest and most sustained BP improvements (typically 5–9 mmHg SBP reduction) and highest control rates. Visual syntheses confirmed superior consistency and magnitude of effects in combined and telemonitoring approaches. Conclusion: Multicomponent interventions integrating self-management with telemonitoring and clinical support yield the greatest BP control benefits. Future programs should prioritize integrated, patient-centered strategies.

Key words: Blood Pressure Control; Self-Management; Telemonitoring; mHealth; Digital Health; Multicomponent Interventions; Systematic Review