Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Abstract

Background
Remote home blood pressure monitoring (HBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of HBPM for urban hypertensive patients.

Methods
We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of HBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control.

Results
We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for HBPM for SBP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212: 95% confidence interval, 0.148 to 0.275; P < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, P < 0.001) and the effect of HBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; P = 0.018).

Conclusion
This review demonstrates that HBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of HBPM in preventing hypertensive cardiovascular complications.