Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review

Abstract

Hypertension remains the leading cause of cardiovascular disease worldwide and disproportionately impacts patients living in low- and middle-income countries (LMICs). Telemedicine offers a potential solution for improving access to health care for vulnerable patients in LMICs. Objectives The purpose of this scoping review was to summarize the evidence for telemedicine interventions for blood pressure management in LMICs and assess the relationships between the telemedicine intervention characteristics and clinical outcomes. Design Published studies were identified from the following databases (from their inception to May 2020): PubMed, Scopus, and Embase. Search terms related to “Low and Middle Income Countries,” “Telemedicine,” and “Hypertension” were used, and clinical outcomes were extracted from the screened articles. Results Our search resulted in 530 unique articles, and 14 studies were included in this review. Five studies assessed telemedicine interventions for patient-provider behavioral counseling, four assessed patient-provider medical management, and five assessed provider-provider consultation technologies. Out of fourteen individual studies, eleven demonstrated a significant improvement in systolic or diastolic blood pressure in the intervention group. Of the eight studies that reported difference-in-differences changes in systolic blood pressure, between-arm differences ranged from 13.2 mmHg to 0.4 mmHg. Conclusions The majority of the studies in this review demonstrated a significant reduction in blood pressure with use of the telemedicine intervention, though the magnitude of benefit was not consistently large. Limitations of the studies included small sample sizes, short duration, and intervention heterogeneity. Current evidence suggests that telemedicine may provide a promising approach to increase access to care and improve outcomes for hypertension in LMICs, especially during events that limit access to in-person care, such as the COVID-19 pandemic. However, high-quality clinical trials of sufficient size and duration are needed to establish the impact and role of telemedicine in hypertension care. The protocol for this review was not registered.

Telemedicine in Low- and Middle-Income Countries During the COVID-19 Pandemic: A Scoping Review

“…Prior research includes, for example, a scoping review conducted by Hoffer-Hawlik et al ( 8 ), who investigated telemedicine interventions for blood pressure control in LMICs and found that blood pressure was significantly reduced in telemedicine interventions, although the magnitude of the impact was not always substantial. They concluded that telemedicine may be an effective technique for boosting access to care and enhancing outcomes for hypertension in LMICs, especially during events that limit access to in-person care, such as the COVID-19 pandemic.…”

Digital health innovations for non-communicable disease management during the COVID-19 pandemic: a rapid scoping review

“…However, some of the challenges they and the telemedicine literature highlight hold relevance to our findings broadly. These have to do with technological barriers, digital literacy, financial and security aspects 17 42 48–52. We found an inequitable regional distribution in DHI implementation with most implementations in the Americas, especially the USA.…”

“…Digital technologies are increasingly being recognised as critical innovations to strengthen health services delivery systems 54–56. Thus, it becomes imperative to address the above aspects for scalability and continued uptake, considering the widespread use and integration of telemedicine in routine NCD care 49. COVID-19 restrictions made digital solutions necessary in many social sectors, and this society-wide transition is poised to significantly change the ways in which whole societies engage in, and enact health 57.…”

The Contribution of Exercise in Telemedicine Monitoring in Reducing the Modifiable Factors of Hypertension—A Multidisciplinary Approach

“…In these studies, increased physical activity levels were advised and monitored by simply using a pedometer or an accelerometer. Aerobic exercise was shown as an effective treatment for blood pressure improvement in hypertensive patients [13,41,42] Evidence suggests that the aerobic exercise performed at 65-75% heart rate reserve, 90-150 min/week [6], shows overall reductions in SBP of −4.1 mmHg and DBP of −2.2 mmHg; the blood pressure lowering effects of dynamic resistance (90-150 min per week, 50-80% one repetition maximum, six exercises, three sets per exercise, ten repetitions per set) were −3.7 mmHg and −2.7 mmHg for systolic and diastolic blood pressure, respectively [39]. When combined, the overall effects of aerobic training and resistance exercise are reductions of −5.5 mmHg and −4.1 mmHg.…”

“…According to Ruberti et al [44], safety assessment in a home-based exercise intervention is crucial, and a careful evaluation of the electronic medical record, multidisciplinary consultations, and self-monitoring are important strategies to guarantee the intervention security and effectiveness. Still, no reference to exercise professionals is apparent in several reviews focusing on telemedicine interventions in hypertension management [13,45,46]. A comprehensive study including cardiorespiratory fitness, physical fitness levels, muscle function, traditional cardiovascular risk factors, and health-related quality of life, compared the long-term effects of a 12-week home-based physical training intervention with telemonitoring guidance to a prolonged 12-week center-based cardiac rehabilitation intervention, showing no differences between the two program settings in exercise capacity and physical activity levels [32].…”