Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Abstract

Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120–7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482–3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154–1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (−5.999–11.999) before 2000 and 8.755 mmHg (5.177–12.334) in 2020. DBP reduced by 2.000 mmHg (−2.724–6.724) before 2000 and by 3.529 mmHg (1.221–5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013–1.198) and in 2020 (RR = 1.906, 1.462–2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.

Nurse-led telehealth intervention effectiveness on reducing hypertension: a systematic review

“…Four of the studies reported including experienced nurses in the field of chronic disease management [ 6 , 30 , 31 , 33 ], one included a nurse manager [ 34 ], two studies highlighted the need to have the nurses go through a special course on cultural competency [ 32 ] and formal training on telephone health coaching [ 35 ] prior to participating in the study. Other studies have reported that Registered Nurses (RN) have the undergraduate preparation to promote healthy lifestyles, prevent the development of disease and deliver care and follow-up to different health conditions on community heath setting [ 42 , 43 ], never the less, telehealth content and experiences among different levels of nursing education appeared to remain low [ 44 ].…”

Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review

“…Although HBPT has been used extensively in various patient populations with hypertension [59][60][61][62][63][64] , only a few studies have assessed the benefits of HBPT for BP control and other outcomes assessment in patients with CKD. In the Telemonitoring and Self-Management in Hypertension 4 (TASMINH4) trial, after 12 months, adjusted SBP mean differences (self-monitoring and telemonitoring groups) vs. usual care was -3.5 mmHg [95%CI: -5.8 to -1.2] and -4.7 mmHg [-7.0 to -2.4]), respectively [64] .…”

Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol

“…Of 175 international systematic reviews identified in PubMed (date of search: 9 December 2022), 10 potentially relevant reviews described impact on glycaemic control,17–20 diabetic ketoacidosis21 and interventions to recover or sustain diabetes or hypertension care 22–26. Overall, improvements in glycaemic control were seen in high-income countries during the pandemic, likely reflecting a high motivation for diabetes self-management due to associations with COVID-19 outcomes, supportive care through teleconsultations, and easier meal-planning, improved sleep habits and reduced access to fast food when staying at home during movement restrictions 17 18.…”

“…Four systematic reviews reported on interventions to sustain diabetes or hypertension care during the COVID-19 pandemic internationally,22 23 25 26 and one review protocol was identified 24. Telehealth and home visits were mentioned as modalities to manage diabetic foot conditions 25.…”

“…Therapies enabling longer durations between consecutive treatments and better triaging of high-risk patients were mentioned as strategies to mitigate healthcare disruptions in a study on diabetes-related retinal deterioration 23. Two reviews indicated self-monitoring of blood pressure as a suitable alternative approach to support hypertension management 22 26. Moreover, a systematic review protocol was identified of a study investigating the impact of telehealth on the quality of life among paediatric diabetes patients 24.…”