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Table 3 Summary table of included reviews - hypertension

From: Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews

Citation NHMRC level of evidence Included studies Total participants Participants condition Inclusion criteria Intervention Outcomes Results Conclusion
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.