Self-Measured Blood Pressure-Guided Pharmacotherapy : A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials
BACKGROUND: The optimal approach to implementing telemedicine hypertension management in the United States is unknown.
METHODS: We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials].
RESULTS: Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials.
CONCLUSIONS: Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:81 |
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| Enthalten in: |
Hypertension (Dallas, Tex. : 1979) - 81(2024), 3 vom: 01. Feb., Seite 648-657 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Acharya, Sameer [VerfasserIn] |
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| Links: |
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| Themen: |
Adult |
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| Anmerkungen: |
Date Completed 16.02.2024 Date Revised 16.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1161/HYPERTENSIONAHA.123.22109 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366797689 |
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| 245 | 1 | 0 | |a Self-Measured Blood Pressure-Guided Pharmacotherapy |b A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: The optimal approach to implementing telemedicine hypertension management in the United States is unknown | ||
| 520 | |a METHODS: We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials] | ||
| 520 | |a RESULTS: Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials | ||
| 520 | |a CONCLUSIONS: Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a adult | |
| 650 | 4 | |a blood pressure | |
| 650 | 4 | |a humans | |
| 650 | 4 | |a self-management | |
| 700 | 1 | |a Neupane, Gagan |e verfasserin |4 aut | |
| 700 | 1 | |a Seals, Austin |e verfasserin |4 aut | |
| 700 | 1 | |a Kc, Madhav |e verfasserin |4 aut | |
| 700 | 1 | |a Giustini, Dean |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, Sharan |e verfasserin |4 aut | |
| 700 | 1 | |a Taylor, Yhenneko J |e verfasserin |4 aut | |
| 700 | 1 | |a Palakshappa, Deepak |e verfasserin |4 aut | |
| 700 | 1 | |a Williamson, Jeff D |e verfasserin |4 aut | |
| 700 | 1 | |a Moore, Justin B |e verfasserin |4 aut | |
| 700 | 1 | |a Bosworth, Hayden B |e verfasserin |4 aut | |
| 700 | 1 | |a Pokharel, Yashashwi |e verfasserin |4 aut | |
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