Introduction: With diagnostic criteria for hypertension shifting from 140 mmHg to 130 mmHg globally, an estimated number of 300 million people in China would be newly diagnosed if the criteria is applied. However, the premature use of antihypertensive drugs on these people will result in unnecessary economic burden. This study aims to explore the effectiveness and cost-effectiveness of non-pharmacological interventions for prehypertensive patients, and to suggest potential models for community-based chronic diseases management in China.

Methods: We searched for relevant studies from major databases both in English and Chinese. Currently widely used 13 non-pharmacological interventions were categorized and standardized into 5 groups. We used network meta-analysis to rank the effectiveness (e.g: reduction of blood pressure) among groups, and a 9-state Markov model to project the outcome to lifetime. A simple budget impact analysis was conducted to see when the invest on managing the prehypertensive patients would be reclaimed.

Results: A total of 30 studies and 4846 subjects are included. Traditional Chinese Medicine Physiotherapy is the most advantageous group as compared to lifestyle (MD=-6.27, 95%CI [-9.65, -2.95]), strengthen exercise (MD=-0.76, 95%CI [-5.51, 3.95]), relaxation (MD=-0.56, 95%CI [-6.31, 5.22]) and diet therapy (MD= -2.84, 95%CI [-8.12, 2.40]). Among which, Tai Chi, combined exercises and massage are the three interventions with the best antihypertensive effect. When the willingness-to-pay is set as 1 or 3 times per capita Chinese GDP, the most cost-effective intervention group were strengthening exercise (ICER=7107.87) or relaxation (ICER=18298.38), respectively; both of them would start to pay off in the third year of managing the prehypertensive patients. Sensitivity analysis showed that the base-case analysis is robust.

Discussion: To include prehypertensive people into routine community-based disease management is potentially worthy in the long run, and strengthen exercise and relaxation are the most promising interventions when considering both effectiveness and cost-effectiveness in China.