A systematic review of patient decision aids for hypertension

Clinical Snapshot

Key Findings

• Effect Size: Not applicable — no comparative effectiveness data; IPDAS quality scores ranged from 49/116 to 87/116 across the five included PDAs

• Primary Outcome: Identification and IPDAS quality evaluation of PDAs for arterial hypertension: five PDAs identified from 1,874 screened records, developed between 2019 and 2024, originating from the United States, United Kingdom, and Germany

• Nnt Or Sensitivity: Not applicable — no clinical effectiveness outcomes assessed; all five PDAs addressed medication and lifestyle options; number of individual treatment options presented ranged from 2 to 12 per PDA

• Confidence Interval: Not reported — narrative synthesis only; no pooled estimates calculated

Clinical Application

All five identified PDAs are accessible online, supporting feasibility of integration into clinical workflows. However, variable IPDAS quality scores (49–87/116) mean that not all PDAs meet minimum quality thresholds for confident clinical recommendation. Clinicians wishing to use PDAs should preferentially select tools with higher IPDAS compliance. Implementation feasibility in time-pressured primary care consultations, and for patients with low digital literacy or limited English proficiency, remains undemonstrated. Hypertension affects approximately 34% of Australian adults and is a leading contributor to cardiovascular disease burden (Australian Institute of Health and Welfare data). The RACGP Guidelines for the Management of Absolute Cardiovascular Disease Risk and the National Heart Foundation of Australia guidelines both emphasise patient-centred care and shared decision-making in hypertension management. No Australian-developed PDA was identified in this review, representing a clear gap. The TGA does not regulate PDAs as therapeutic goods, but RACGP and the Australian Commission on Safety and Quality in Health Care (ACSQHC) have frameworks supporting SDM tool development. PBS-listed antihypertensive agents span multiple drug classes; a high-quality Australian PDA would need to reflect local formulary options, Medicare-rebated lifestyle programs (e.g., Chronic Disease Management plans), and culturally appropriate content for Aboriginal and Torres Strait Islander communities and CALD populations. Adults with diagnosed arterial hypertension engaged in shared decision-making consultations regarding antihypertensive pharmacotherapy and/or lifestyle modification. Applicability is currently strongest in English-speaking and German-speaking healthcare contexts given the origin of identified PDAs.

Abstract

BACKGROUND: Hypertension is a major cause of premature death and a modifiable risk factor for cardiovascular disease. Effective management includes both pharmacological treatment strategies, including antihypertensive medications, and non-pharmacological treatment strategies, such as lifestyle changes. Shared decision making (SDM) between patients and healthcare professionals is essential to determine the most appropriate treatment for hypertension. Patient decision aids (PDAs) facilitate SDM by providing information on treatment options and helping patients to clarify their values and preferences. However, there is no comprehensive comparison of PDAs for hypertension. OBJECTIVE: This systematic review aimed to identify and evaluate PDAs for arterial hypertension using the International Patient Decision Aid Standards (IPDAS) criteria. METHODS: A comprehensive search of bibliographic databases (PubMed, Embase) and gray literature (Google Scholar, Google) was performed in October 2023 and updated in April 2026. Studies and tools were included if they presented a PDA for patients with arterial hypertension, met the IPDAS definition of a PDA and were in German or English. Two researchers screened the literature, extracted data and assessed the quality of the PDAs using the IPDAS Minimal Criteria. Data were synthesized narratively. RESULTS: Of 1,874 records screened, five PDAs met the inclusion criteria. These PDAs were developed between 2019 and 2024 and originated from the United States, United Kingdom, and Germany. All PDAs addressed the two option areas of medication and lifestyle but differed in the number of individual treatment options presented (range: 2-12 options) and the level of detail in which the options were addressed. All five PDAs were accessible online. Common design features of the PDAs included an option grid format for presenting treatment options with associated benefits and adverse effects, visuals and graphics to enhance comprehension, and value clarification. Quality assessments showed varying levels of compliance with the IPDAS criteria, with overall scores ranging from 49/116 to 87/116. CONCLUSIONS: Few PDAs exist despite the prevalence of hypertension. PDAs varied in quality and format, highlighting gaps in the development process. Further research is needed to evaluate the effectiveness of PDAs for hypertension and to determine which formats are most effective in supporting SDM in different patient populations. CLINICAL TRIAL NUMBER: Not applicable.

References

1. 1.Berghold, J., Fischer, L., Pachanov, A., Schewe, L. V., & Pieper, D. (2026). A systematic review of patient decision aids for hypertension. BMC Medical Informatics and Decision Making. https://doi.org/10.2196/39490