Understanding Moderators of Home Blood Pressure Telemonitoring Systems in Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Abstract

Background:Factors affecting the effectiveness of telemonitoring in home blood pressure telemonitoring (HBPT) must be examined in an integrated analysis in urban hypertensive patients. Materials and Methods:In a systematic review of electronic databases, we retrieved 1,433 citations and selected 34 comparisons. Specified moderators were the duration of the intervention, the frequency of remote transmission of blood pressure (BP) data, the additional intervention, and the intervention pathway. Results:For the duration of follow-up of HBPT, the weighted mean difference (WMD) in systolic blood pressure (SBP) between two groups was 11.900 mmHg (p-value <0.001) at 2 months and 3.024 mmHg (p = 0.002) at 12 months. The WMD in SBP was 5.512 mmHg (p < 0.001) in cases where data were transmitted daily and 1.818 mmHg (p = 0.084) for monthly transmission. For the group in which further interventions with HBPT were conducted, the WMD in SBP was 3.813 mmHg (p < 0.001). For patients who did not receive additional interventions, the WMD was 2.747 mmHg (p = 0.005). For the pathway of HBPT, the WMD was 6.800 mmHg (p = 0.053) when BP values were remote transmitted through letter, 3.041 mmHg (p = 0.001) through mobile phone/web, 2.224 mmHg (p = 0.043) through telephone-linked computer system, and 4.352 mmHg (p < 0.001) through telephone. Conclusions:The effects of moderators of HBPT systems utilized with urban hypertensive patients differ from those in interventions that did not distinguish urban from rural areas. Results for duration of implementation and frequency of data transmission were significant. Among the interventions using telecommunications, the telephone was the most effective in comparison to other channels.