Effectiveness of chatbot interventions in individuals for hypertension management: a systematic review and narrative synthesis.

Introduction: Hypertension is a major global risk factor for cardiovascular disease and requires long-term management. Recently, digital health tools such as chatbots have been introduced to support patient self-management. This systematic review aims to assess the effectiveness of chatbot interventions designed for individual hypertension management evaluating their impact on clinical outcomes, primarily changes in systolic and diastolic blood pressure and to explore the improvement in knowledge and self-management skills, as well as implementation outcomes such as feasibility, acceptability, and adoption in routine healthcare settings. Materials and methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The research question was structured by the PICOT framework, focusing on patients with hypertension or elevated Blood Pressure (BP) receiving chatbot-based interventions compared with usual care or other digital approaches, with outcomes including changes in systolic and diastolic BP, medication adherence, behaviour changes, implementation outcomes, and improvement in knowledge and self-management skills. A literature search was conducted in PubMed, Embase, Scopus and Web of Science for studies published from 2015 onwards, identifying 316 studies, of which 177 underwent title and abstract screening and 9 were finally included. Two independent reviewers performed screening and full-text review and assessed quality using Covidence. Inter-Rater Reliability (IRR) was assessed using pairwise Cohen's Kappa ( Results: Evidence is heterogeneous and mostly low-to-moderate certainty. Chatbot interventions were associated with improvements in both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), medication adherence, and adherence to home BP monitoring. Improvements in self-monitoring and engagement were more consistent across studies, while BP and medication adherence outcomes varied, with some studies reporting limited or non-significant effects. Discussion/conclusion: Chatbot interventions show potential as an accessible tool to support hypertension self-management. They may help improve patient engagement and monitoring behaviours, however, their effects on BP and medication adherence vary and may depend on intervention design and how they are used in practice. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251172042, PROSPERO CRD420251172042.