Effectiveness of behavioural change interventions on primary stroke risk reduction among adults and older adults with hypertension: a systematic review of randomized controlled trials

Stroke remains a leading global cause of death and disability, with hypertension as its most preventable risk factor. Since most strokes occur as first-time events, primary prevention targeting modifiable risk factors is essential to reduce its burden. The review applied the PICOs framework to guide the inclusion and exclusion of studies assessing behavioural interventions for primary stroke risk reduction. This systematic review narratively synthesised behavioural interventions for primary stroke prevention among hypertensive adults, focusing on studies published from 2014 to June 2024. The review was conducted in accordance with the JBI methodology for systematic reviews of effectiveness evidence and the PRISMA checklist. Two randomised controlled trials met the inclusion criteria. The first, the KM2H2 intervention, combining physical activity programs with education and counselling, significantly reduced stroke incidence at six and 30 months. The second, a technology-based program using videos and leaflets, achieved a 44.86% reduction in predicted stroke risk scores compared to 17.56% in controls at 3 months. Both RCTs showed significant reductions in stroke risk despite differing behavioural approaches, demonstrating their value in addressing modifiable factors among hypertensive adults. Longitudinal evidence supports this potential, though further high-quality research is needed to confirm effectiveness.