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.
Meta-Analysis
Yes
Does telemedicine hypertension management improve blood pressure reduction and control compared to usual clinic-based care in US patients?
Telemedicine hypertension management is more effective than clinic-based care in the US, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support.
Effect estimate: Difference -7.3 mm Hg (95% CI -9.4 to -5.2)
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.
Acharya et al. (Mon,) 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.