[2020-04]
Understanding Moderators of Home Blood Pressure Telemonitoring Systems in Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Woo Seok Choi 

Moon Soul Graduate School of Future Strategy, KAIST

Jae-Suk Yang

Moon Soul Graduate School of Future Strategy, KAIST

In-Soo Shin

Department of Transdisciplinary Security, Dongguk University

ABSTRACT  
Background: Factors affecting the effectiveness of telemonitoring in home blood pressure (HBPT) must be examined in an integrated analysis in urban hypertensive patients. Methods and Materials: 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 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 mm Hg (p-value (P) < 0.001) at two months and 3.024 mm Hg (P = 0.002) at 12 months. The WMD in SBP was 5.512 mm Hg (P < 0.001) in cases where data were transmitted daily and 1.818 mm Hg (P = 0.084) for monthly transmission. For the group in which further interventions with HBPT were conducted, the WMD in SBP was 3.813 mm Hg (P < 0.001). For patients who did not receive additional interventions, the WMD was 2.747 mm Hg (P = 0.005). For the pathway of HBPT, the WMD was 6.800 mm Hg (P = 0.053) when BP values were remote transmitted via letter, 3.041 mm Hg (P = 0.001) via mobile phone/web, 2.224 mm Hg (P = 0.043) via telephone-linked computer system, and 4.352 mm Hg (P < 0.001) via 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.
 
Keywords: urban, hypertension, moderators, home blood pressure telemonitoring