Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies

Abstract

To summarise evidence about the effectiveness of home blood pressure telemonitoring (HBPT) and identify the key components of intervention. We comprehensively searched PubMed, EMBASE and the Cochrane Library for relevant studies. The authors were contacted for additional information. Two authors independently extracted the data and assessed the risk of bias. 46 randomised controlled trials including a total of 13 875 cases were identified. Compared with usual care, HBPT improved office systolic blood pressure (BP) and diastolic BP by 3.99 mm Hg (95% confidence interval (CI): 5.06-2.93; P<0.001) and 1.99 mm Hg (95% CI: -2.60 to -1.39; P<0.001), respectively. A larger proportion of patients achieved BP normalisation in the intervention group (relative risk (RR): 1.16; 95% CI: 1.08-1.25; P<0.001). For HBPT plus additional support (including counselling, education, behavioural management, medication management with decision, adherence contracts and so on) versus HBPT alone (or plus less intense additional support), the mean changes in systolic and diastolic BP were 2.44 mm Hg (95% Cl, 4.88 to 0.00 mm Hg; P=0.05) and 1.12 mm Hg (95% CI, -2.34 to 0.1 mm Hg; P=0.07), respectively. For those surrogate outcomes, low-strength evidence failed to show difference. In subgroup analysis, high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel. HBPT can improve BP control in the hypertensive patients. It may be more efficacious when a proactive additional support is provided during the intervention process.

Home blood pressure telemonitoring in the 21st century

“…Recently, an updated meta‐analysis of 46 randomized controlled trials with 13 875 cases confirmed the superiority of BPT on usual care in terms of improvement of BP control, although the results of this meta‐analysis should be considered with some caution given the occurrence of many mistakes in the selection and interpretation of the included studies. This meta‐analysis, in the context of its limitations, showed low‐strength evidence of efficacy of BPT for surrogate outcomes, whereas it suggested that longer‐term (6 to 12 months vs <6 months) home BPT accompanied by counseling support from study personnel may result in lower BP values.…”

Prospects for Blood Pressure Remote Monitoring in Hypertensive Patients in the Ryazan Region

“…Использование данной технологии способствует снижению загруженности участковых терапевтов и одновременно увеличивает охват диспансерным наблюдением больных с ГБ. Телемедицинские технологии существенно повышают эффективность антигипертензивной терапии и приверженность больных к лечению благодаря регулярным контактам пациента с врачом, в том числе, и с помощью телефонной связи [6][7][8]. На сегодняшний день имеется достаточный международный и отечественный опыт, нормативно-методическая база и доступное оборудование, что позволяет повсеместно расширять практику дистанционного наблюдения за больными ГБ [6].…”

Investigation and management of adult hypertension

“…In addition to being a significant prognostic indicator of target organ damage, cardiovascular mortality and cardiovascular events,61 HBP monitoring can be supplemented with telemonitoring, incorporating recent advances in digital technology to enable patient-clinician feedback. Meta-analyses have shown that HBP telemonitoring can improve BP control,62 and that the provision of additional support (e.g. counselling, education, behavioural management and adherence contracts) may have an additive beneficial effect, but did not reach statistical significance 62.…”

“…Meta-analyses have shown that HBP telemonitoring can improve BP control,62 and that the provision of additional support (e.g. counselling, education, behavioural management and adherence contracts) may have an additive beneficial effect, but did not reach statistical significance 62. Home telemonitoring is also associated with increased prescribed medications, changes in behaviour such as self-reported salt intake, improved medicines adherence63 64 and appears well-tolerated 65…”