Lifestyle Interventions and Pharmacological Adherence in the Management of Hypertension Among Community-Dwelling Older Adults: A Systematic Review.

Hypertension prevalence is rising, particularly among older adults, who are often challenging to manage due to various limitations. Uncontrolled hypertension contributes significantly to complications and disease burdens, including myocardial ischemia and stroke, ultimately impairing functional ability and diminishing overall quality of life. This study aimed to review the components, details, and effects of hypertension management interventions among older adults. The protocol was prospectively registered in PROSPERO for verification and guidance. We searched across eleven databases: PubMed, CINAHL, Scopus, ProQuest, PsycINFO, AgeLine, ScienceDirect, ThaiList, ThaiJO, Cochrane Library, and OneSearch. Studies among older adults published between January 2019 and February 2025 were included in this review. The initial results included 15,024 identified records; 16 studies met the inclusion criteria, comprising 10 randomized controlled trials and six quasi-experimental studies, with a total of 1857 participants. The multicomponent interventions produced the largest and most consistent blood pressure reductions, with SBP decreases up to -21.90 mmHg and DBP up to -9.46 mmHg. These effects were associated with moderate-duration programs (10-16 weeks), repeated structured contact, and reinforcement mechanisms. In contrast, lower-intensity or single-component interventions yielded smaller or inconsistent effects. Therefore, the findings indicate a clear gradient of effectiveness, with greater SBP reduction associated with increasing intervention complexity and integration. These results highlight the importance of designing interventions that move beyond single-component education toward multilevel behavioral systems, particularly for older adults with diverse capabilities and support needs. The secondary outcomes demonstrated a similar but less pronounced gradient compared to blood pressure, with multicomponent interventions consistently producing the most favorable improvements in medication adherence, health behaviors, and hypertension-related knowledge. In conclusion, multicomponent interventions with high-intensity interventions produce the most consistent improvements in blood pressure and related behaviors among older adults, highlighting that effectiveness is driven by integrated strategies, reinforcement, and implementation quality rather than single-component approaches.