Table 3 Summary table of included reviews - hypertension

Agarwal et al. [17]

I

37

9446

Hypertension

• Published between 1966-2010

Home BP monitoring compared to a control group.

• BP - diastolic, systolic and mean arterial

• Medication use

Compared with clinic based measurements, home based BP monitoring; • Improved systolic BP (SMD −2.63 mmHg, 95% CI −4.24 to −1.02; 22 studies) • Improved diastolic BP (SMD - 1.68 mmHg, 95% CI −2.58 to −0.79 mmHg; 22 studies) • Improved mean arterial pressure (SMD −4.0 mmHg, 95% CI −6.22 to −1.79 mmHg; 3 studies) • Reduced medication use (RR 2.02, 95% CI 1.32 to 3.11; 10 studies) • Reduced therapeutic inertia (RR 0.82, 95% CI 0.68 to 0.99; 15 studies) • Led to no greater increase in medication (RR 0.94, 95% CI 0.75 to 1.19; 12 studies)

• Compared with clinic BP monitoring alone, home BP monitoring had the potential to overcome therapeutic inertia [no change in medication].

• Lead to a small but significant reduction in systolic and diastolic BP.• Hypertension management with home BP monitoring can be enhanced when used with telemonitoring.

Neubeck et al. [18]

I

11

3145

Coronary Heart Disease

• English language

• Published between 1990-2008

Intervention involved home monitoring with 50% patient provider contact for risk factor modification and advice/counselling for CHD patients

• All-cause mortality

• Modifiable risk factors including cholesterol (and associated measures), BP, BMI, Smoking Status, Physical Activity

• Quality of life

• Cost

Compared to the control group the evidence suggests that the intervention group had;

• Reduced total cholesterol (WMD 0.37 mmol/L, 95% CI: 0.19 to 0.56, 9 studies)

• Reduced low-density lipoprotein cholesterol (WMD 0.41 mmol/L, 95% CI: 0.36 to 0.56, 4 studies)

• Reduced systolic blood pressure (WMD 4.69 mmHg, 95% CI 2.91 to 6.47, 7 studies)

• Reduced risk of smoking (RR 0.83, 95% CI: 0.70 to 0.99, 7 studies)

• Telemonitoring interventions provided effective risk factor reduction and secondary prevention in patients with CHD.

• Telemonitoring could increase the uptake of formal secondary prevention by those who do not access cardiac rehabilitation, and narrow the current gap between evidence and practice.

• Telephone based telemonitoring – 9 studies

• Internet based telemonitoring – 2 studies

Omboni et al. [19]

I

12

5044

Hypertension

• English language

• Published between inception - 2010

Home BP monitoring with data being automatically transferred compared to control group.

• Change in BP (diastolic, systolic and normalisation)

• Medication

Compared to controls the overall effect of home BP monitoring was;

• Improved office systolic BP (5.64 mm Hg, 95% CI: 7.92 to 3.36 mm Hg, 11 studies)

• Improved office diastolic BP (2.78 mm Hg, 95% CI: 3.93 to 1.62 mm Hg, 11studies)

• Improved ambulatory systolic BP (2.28 mm Hg, 95% CI: 4.32 to 0.24 mm Hg; 3 studies)

• Improvement in BP control (RR 1.31, 95% CI: 1.06 1.62, 5 studies)

• Home blood pressure telemonitoring may represent a useful tool to improve blood pressure control but well-designed large-scale trials are still needed to demonstrate its clinical usefulness.

Verberk et al. [20]

I

9

2662

Hypertension

• English language

• No restriction on dates reported

Home BP transmitted via telephone, internet, modem or mail.

• BP - diastolic, systolic

• Medication

• Increased use of antihypertensive medications (WMD +0.22, 95% CI: +0.02, +0.43, 5 studies)

Compared with usual care, home based BP monitoring;

• Reduced systolic BP (5.19 mmHg, 95% CI 2.31 to 8.07; 9 studies)

• Reduced diastolic BP (2.11 mmHg, 95% CI 0.52 to 3.69; 9 studies)

• There was no significant difference between groups in the number of patients that reached their target blood pressure (3 studies)

• Telecare led to a greater decrease in systolic and diastolic blood pressure than usual care. For systolic blood pressure, this decrease was greater in trials without treatment modification.