Systematic review of the impact of digital health technologies on blood pressure control and treatment adherence in young and middle-aged hypertensive patients

Objective The aim of this work is to evaluate the effect of digital intervention technologies on blood pressure management and medication adherence in hypertensive individuals aged 18–59 years and to explore pathways for precise health management. Methods Randomized controlled trials (RCTs) published up to April 2025 were systematically searched in PubMed, Embase, Cochrane Library, Web of Science, and four major Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Data, and Vip Journal Integration Platform). The intervention group received digital interventions such as mobile health apps, remote monitoring, or smart wearable devices, while the control group received routine health education. The Cochrane Risk of Bias tool was used for literature quality assessment, and data analysis was performed using RevMan 5.4 software. Results A total of 12 studies ( n = 1,879) were finally included. Meta-analysis revealed the following: (1) Systolic blood pressure (SBP) decreased by 2.95 mmHg (WMD = −2.95, 95%CI: −4.22 to −1.69). (2) Diastolic blood pressure (DBP) decreased by 3.34 mmHg (WMD = −3.34, 95%CI: −4.63 to −2.06). (3) Medication adherence significantly improved (MD = 2.39, 95%CI: 0.98–3.79, P = 0.0009). Considerable heterogeneity was observed in adherence outcomes (I ² = 93%). Subgroup analysis based on intervention duration indicated a significant effect within the 24-week subgroup (MD = 2.75, 95%CI: 0.67–4.83), while the 12-week subgroup did not reach statistical significance (MD = 1.85, 95%CI: −0.82–4.52). Conclusion Digital health interventions can improve blood pressure control in young and middle-aged hypertensive patients and show potential to enhance medication adherence. However, the observed high heterogeneity and differential effects based on intervention duration suggest that effectiveness may vary. This study provides evidence-based support for the application of digital tools in chronic disease management, while highlighting the need for more tailored and standardized approaches.