An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension.

Sang-Hyun Park,Woo-Seok Choi,Jong-Ho Shin,Joowoong Park

doi:10.3390/ijerph182010583

Abstract

Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM’s inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339–0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209–0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107–1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.

Highlights

Hypertension is widely recognized as the most important risk factor for cardiovascular disease (CVD), which is a major cause of total mortality [1]
For the remaining 512 articles, the full text was obtained and scrutinized, and studies without available data (n = 206), studies not performed in an urban area, studies either reporting combined results of urban and rural areas or not reporting the area (n = 192), studies conducted on patients with CVD or cerebrovascular accident (CVA) that may induce a sudden change in blood pressure (BP), studies conducted on patients undergoing hemodialysis or including patients with chronic renal disease, and studies involving female patients before or after pregnancy (n = 46) or patients aged
192), studies conducted on patients with CVD or CVA that may induce a sudden change in BP, studies conducted on patients undergoing hemodialysis or including patients with chronic renal disease, and studies involving female patients before or after pregnancy (n or patients aged

Summary

Introduction

Hypertension is widely recognized as the most important risk factor for cardiovascular disease (CVD), which is a major cause of total mortality [1]. A 2 mmHg fall in systolic blood pressure (SBP) has been reported to reduce the incidence of ischemic CVD and stroke by 7% [2]. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) treatment recommendations state that BP must be controlled to stricter levels [5,6]. Remote BP monitoring (RBPM) has been recommended for hypertension diagnosis and treatment [5,6], as it has been reported to predict CVD morbidity and mortality with higher accuracy than office BP monitoring [7]. As a method of telemedicine, RBPM is known to be an effective tool to enhance drug adherence and BP control in patients with hypertension [8,9,10,11,12].

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Discussion

Conclusion