Tracking your higher level areas of focus and your day to day next actions are very different things, so there's no reason that they have to be in the same kind of system, as long as they're still parts of one whole.
I'm mostly digital, but my areas of focus (which i review every week or two) are in a moleskine journal.
For me, reflecting on my areas of focus is about more than simply recalling a list. Checking that, say, my relationship with family members is on course, or that Im paying enough attention to my physical fitness; these are items that I need to think about in a different way to choosing what phone call to make next. So I sit in a cafe and write in my moleskine for an hour. Any projects or next actions that I generate then get transferred into my list manager (I use Tooldledo) to get caught up in the weekly review.
It might be neat to have all your lists from 50K to next action in a single piece of software, but sometimes a specialist tool might suit you better.