Key result
Telemedicine hypertension management reduces systolic BP by ~7 mm Hg vs. usual care.
Why the study?
The optimal approach to implementing telemedicine hypertension management in the United States is unknown.
Does telemedicine hypertension management improve blood pressure reduction and control compared to usual clinic-based care in US patients?
Meta-Analysis
Yes
Does telemedicine hypertension management improve blood pressure reduction and control compared to usual clinic-based care in US patients?
Effect estimate: Difference -7.3 mm Hg (95% CI -9.4 to -5.2)
Telemedicine hypertension management is more effective than clinic-based care in the US, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support.
Supports telemedicine hypertension management in US practice; confirms and extends RCT evidence for BP reduction and control.
BACKGROUND: The optimal approach to implementing telemedicine hypertension management in the United States is unknown. METHODS: We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials]. RESULTS: Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials. CONCLUSIONS: Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation.
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Acharya et al. (2024) conducted a meta-analysis in Hypertension. Telemedicine hypertension management vs. Usual clinic-based care was evaluated on Difference in systolic blood pressure (Difference -7.3 mm Hg, 95% CI -9.4 to -5.2). Telemedicine hypertension management reduced systolic blood pressure by 7.3 mm Hg (95% CI, -9.4 to -5.2) and improved BP control by 10.1% compared to usual clinic-based care.
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