Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Nondialysis chronic kidney disease (CKD) with hypertension (n=821). Intervention: Home blood pressure telemonitoring (HBPT) with or without management support vs. Usual care (UC) or baseline pre-intervention values (in single-arm studies). Primary outcome: Change in mean systolic blood pressure (SBP) (MD -8.8 mm Hg, 95% CI -16.2 to -1.4, p=0.02).

Q: What does this research mean for the field?

Home blood pressure telemonitoring is associated with significant reductions in systolic and diastolic blood pressure and moderate improvements in kidney function in patients with nondialysis chronic kidney disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shezel Muneer; Ikechi G. Okpechi; Feng Ye; Deenaz Zaidi; Mohammed M. Tinwala; Laura Hamonic; Anukul Ghimire; Naima Sultana; Dan Slabu; Maryam Khan; Branko Braam; Kailash Jindal; Scott Klarenbach; Raj Padwal; Jennifer Ringrose; Nairne Scott‐Douglas; Soroush Shojai; Stephanie Thompson; Aminu K. Bello

doi:10.1177/20543581221106248

Key result

Home blood pressure telemonitoring reduced overall systolic blood pressure and diastolic blood pressure in nondialysis CKD patients.

Figures

Why the study?

Although home blood pressure telemonitoring has demonstrated efficacy for blood pressure control, its effects on cardiovascular and kidney outcomes in patients with nondialysis chronic kidney disease remain unclear.

Does home blood pressure telemonitoring (HBPT) with management support improve blood pressure control and kidney function in adults with nondialysis chronic kidney disease?

Key Points

To evaluate the effect of home blood pressure telemonitoring on cardiovascular-related and kidney disease-related outcomes in patients with nondialysis chronic kidney disease.
Systematic review and meta-analysis of observational studies and randomized controlled trials searched across 7 databases from inception to June 30, 2020.
Included 7 studies (3 randomized controlled trials and 4 observational studies) enrolling 821 adults with nondialysis chronic kidney disease across 6 countries (United States, Belgium, Taiwan, Japan, Canada, and United Kingdom).
Assessed home blood pressure telemonitoring interventions with or without usual care comparator arms; primary outcomes included changes in mean systolic and diastolic blood pressure.
Pooled mean difference for estimated glomerular filtration rate demonstrated a significant improvement of 5.4 mL/min/1.73 m 2 (P < .001).

Study Design

Type

Meta-Analysis (n=821)

Multicenter

Yes

Structured PICO

Does home blood pressure telemonitoring (HBPT) with management support improve blood pressure control and kidney function in adults with nondialysis chronic kidney disease?

P

Population

821 adults across 7 studies (3 RCTs and 4 observational studies) with nondialysis chronic kidney disease (stages 3-5) and hypertension, mean age ranging from 58 to 75.3 years, followed for 10 days to 24 months.

I

Intervention

Home blood pressure telemonitoring (HBPT) using electronic automated blood pressure monitors storing readings obtained at home and transmitting data remotely (via Bluetooth, mobile phone, web/Internet, or telephone line) to healthcare providers, with or without interdisciplinary management support (physicians, nurses, pharmacists) over 10 days to 23 months.

C

Comparator

Usual care (UC) in controlled studies (3 RCTs), or baseline pre-intervention blood pressure values in single-arm before-after observational studies (4 studies).

O

Outcome

Change in mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) (pooled overall and at 3 and 6 months follow-up).surrogate

Main Result

Mean Difference: -8.8 (95% CI -16.2–-1.4)

p-value: p=0.02

Limitations

Significant heterogeneity across included studies in clinical settings, telemonitoring technologies, timing of self-monitoring, and management support.
Small number of available studies (7 total, only 4 in BP meta-analysis) and small overall sample size (821 total participants; 683 in RCTs).
Inability to conduct subgroup analyses by CKD stage due to heterogeneity in CKD definitions and lack of eGFR stratification.
Insufficient power to formally assess publication bias (<10 studies).
Sensitivity analysis using all follow-up data showed that the initial significant improvement in eGFR became statistically nonsignificant.
High heterogeneity across studies regarding clinical settings, telemonitoring technologies, frequency of BP transmissions, and comparative groups
Small number of included studies (7 total, 4 in quantitative meta-analysis) and small pooled sample size (n=821 total, n=130 in overall BP meta-analysis)
Inability to perform subgroup analyses by CKD stage due to heterogeneous CKD definitions and lack of eGFR stratification
Insufficient number of studies (<10) to assess publication bias

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Home blood pressure telemonitoring is associated with modest reductions in systolic and diastolic blood pressure and high patient acceptability in nondialysis CKD, though larger RCTs are needed to confirm effects on kidney function and clinical outcomes.

Abstract

Background: Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of home blood pressure telemonitoring (HBPT) for blood pressure (BP) control and outcomes, but the effects of this intervention remain unclear in patients with CKD. Objective: To determine the impact of HBPT on cardiovascular–related and kidney disease–related outcomes in patients with CKD. Design: Systematic review and meta-analysis. Setting: All studies that met our criteria regardless of country of origin. Participants: Patients with chronic kidney disease included in studies using HBPT for BP assessment and control. Measurements: Descriptive and quantitative analysis of our primary and secondary outcomes. Methods: We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and gray literature from inception for observational and randomized controlled studies in nondialysis (ND) CKD using HBPT for BP control. We selected studies that used HBPT as intervention (with or without a control arm) for BP control in ND-CKD populations. The primary outcome was change in mean systolic BP (SBP) and mean diastolic BP (DBP). Results: We selected 7 studies from 1669 articles that were initially identified. Overall, pooled estimates in the mean difference (MD) for SBP and DBP were −8.8 mm Hg; 95% confidence interval (CI): −16.2 to −1.4; P = .02 and −2.4 mm Hg; 95% CI: −3.8 to −1.0; P < .001, respectively. For studies comparing intervention with usual care (UC), pooled estimate in MD for SBP was −8.0 mm Hg ( P = .02) with no significant reduction for DBP (−2.6 mm Hg; P = .18). In studies without a UC arm, both SBP and DBP were not significantly reduced ( P > .05). The pooled estimate in MD for estimated glomerular filtration rate showed a significant improvement (5.4 mL/min/1.73 m 2 ; P < .001). Limitations: Heterogeneity and few available studies for inclusion limited our ability to identify a robust link between HBPT use and BP and kidney function improvement. Conclusion: Home blood pressure telemonitoring is associated with mild lowering of BP and moderately improved kidney function in patients with CKD. However, larger studies with improved designs and prolonged interventions are still needed to assess the effects of HBPT on patients’ outcomes. PROSPERO registration ID CRD42020190705

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Muneer et al. (2022) conducted a meta-analysis in Nondialysis chronic kidney disease (CKD) with hypertension (n=821). Home blood pressure telemonitoring (HBPT) with or without management support vs. Usual care (UC) or baseline pre-intervention values (in single-arm studies) was evaluated on Change in mean systolic blood pressure (SBP) (MD -8.8 mm Hg, 95% CI -16.2 to -1.4, p=0.02). Home blood pressure telemonitoring reduced overall systolic blood pressure and diastolic blood pressure in nondialysis CKD patients.

synapsesocial.com/papers/6a8ead438a58c5c5391d6fa0 https://doi.org/10.1177/20543581221106248

View Full Paper

Ask AI

Bookmark

Share

Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading