Objective: To systematically review data from randomized controlled studies on the effectiveness of home blood pressure telemonitoring (HBPT) versus usual care with respect to improvement of BP control, healthcare resources utilization and costs, patient's quality of life and adverse events.
Methods: Electronic databases were searched for publications in English. The benefit and relative risk (RR) were estimated applying a random-effect model.
Results: Twenty-three randomized controlled trials with a high level of heterogeneity were selected (7037 patients). Compared to usual care, HBPT improved office SBP by 4.71 mmHg [95% confidence interval (CI): 6.18, 3.24; P < 0.001] and DBP by 2.45 mmHg (3.33, 1.57; P < 0.001). A larger proportion of patients achieved office BP normalization (<140/90 mmHg nondiabetic patients and <130/80 mmHg diabetic patients) in the intervention group [RR: 1.16 (1.04, 1.29); P < 0.001]. HBPT led to a significantly larger prescription of antihypertensive medications [+0.40 (+0.17,+0.62), P < 0.001], but to therapeutic adherence and rate of office consultations similar to usual care. Healthcare costs were significantly (P < 0.001) larger in the HBPT group [+662.92 (+540.81, +785.04) euros per patient], but were similar to those of the usual care when only medical costs were considered [−12.4 (−930.52, +906.23) euros; P = 0.767]. Use of HBPT helped improving the physical component of quality of life [SF-12 or SF-36 questionnaire: +2.78 (+1.15, +4.41) P < 0.001]. No difference was observed in the risk of adverse events [RR: 1.22 (0.86, 1.71); P = 0.111].
Conclusion: HBPT may represent a useful tool to improve hypertension control and associated healthcare outcomes, although it is still more costly compared with usual care.
aItalian Institute of Telemedicine, Varese
bDepartment of Cardiology, IRCCS Ospedale San Luca, Istituto Auxologico Italiano
cDepartment of Clinical Medicine and Prevention, University of Milano Bicocca, Milano, Italy
Correspondence to Stefano Omboni, MD, Italian Institute of Telemedicine, Via Colombera 29, 21048 Solbiate Arno (Varese), Italy. Tel: +39 0331 984529; fax: +39 0331 984530; e-mail: firstname.lastname@example.org
Abbreviations: BP, blood pressure; HBPM, home blood pressure monitoring; HBPT, home blood pressure telemonitoring; MCS, mental component summary; MeSH, medical subject headings; PCS, physical component summary; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Received 4 June, 2012
Revised 30 September, 2012
Accepted 15 November, 2012
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