Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Background: Hypertension is a major contributor to morbidity, mortality, and healthcare costs among older adults in the United States, with rural populations facing higher prevalence, poorer control rates, and reduced healthcare access. Social isolation further exacerbates cardiovascular risk. Telehealth and digital platforms can address both clinical and social support needs, but evidence on integrated approaches in rural hypertensive seniors remains fragmented. Objective: To synthesize and compare the effectiveness of telehealth-based interventions incorporating social support for rural older adults with hypertension in the U.S. and global contexts. Methods: A structured review was conducted using secondary data from published randomized controlled trials, cohort studies, and systematic reviews. Eligible studies involved adults ≥60 years with hypertension, delivered via telehealth or digital platforms, and included a social support component. Outcomes were systolic blood pressure (SBP) change, medication adherence, and psychosocial measures. Comparative synthesis evaluated U.S. versus global interventions. Results: A total of 28 studies (U.S., n=16; global, n=12) were included. Integrated clinical + social support telehealth models achieved greater SBP reductions than clinical-only models (U.S. pooled: −4.24 mmHg [95% CI, −7.33 to −1.14] at 6 months; −4.30 mmHg [95% CI, −8.38 to −0.23] at 12 months; intensive models up to −21.3 mmHg). Global programs achieved similar or higher reductions (−4 to −12 mmHg) when culturally tailored. Adherence gains ranged from 10–20%, with psychosocial improvements linked to peer or caregiver engagement. Scalability depended on infrastructure and cultural adaptation. Conclusions: Telehealth interventions integrating social support improve BP control, adherence, and psychosocial outcomes for rural older adults with hypertension in both U.S. and global contexts. Scaling such models could reduce disparities and inform global cardiovascular care strategies.