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Meta-Analysis
. 2021 Jun 27;18(13):6892.
doi: 10.3390/ijerph18136892.

Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Woo-Seok Choi  1   2 , Nam-Suk Kim  3 , Ah-Young Kim  1 , Hyung-Soo Woo  1
Affiliations
Meta-Analysis

Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Woo-Seok Choi et al. Int J Environ Res Public Health. .

Abstract

Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120-7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482-3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154-1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (-5.999-11.999) before 2000 and 8.755 mmHg (5.177-12.334) in 2020. DBP reduced by 2.000 mmHg (-2.724-6.724) before 2000 and by 3.529 mmHg (1.221-5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013-1.198) and in 2020 (RR = 1.906, 1.462-2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.

Keywords: COVID-19; blood pressure; coordination; hypertension; nurse; telemonitoring; urban.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Cumulative meta-analysis presenting the summative effect at each time point. Note. SBP, systolic blood pressure; UC, usual care; NC-HBPT, nurse-coordinated home blood pressure telemonitoring; Summary effect size (◆); Point estimate of individual study (●).
Figure 1
Figure 1
PRISMA flow diagram of the selection of studies included in the systematic review. Note. HBPT, home blood pressure telemonitoring; RCT, randomized controlled trial; CVD, cardiovascular disease; CVA, cerebrovascular accident; SBP, systolic blood pressure; DBP, diastolic blood pressure; BP, blood pressure.
Figure 2
Figure 2
Funnel plot of systolic blood pressure by Hedges’ g (plot observed and imputed), random effects model. Notes. Summary effect size (◇); Summary effect size of imputed studies (◆); Individual studies (○).
Figure 3
Figure 3
Funnel plot of diastolic blood pressure by Hedges’ g (plot observed and imputed), random effects model. Notes. Summary effect size (◇); Summary effect size of imputed studies (◆); Individual studies (○).
Figure 4
Figure 4
Funnel plot of rate of target blood pressure by log risk ratio (plot observed and imputed), random effects model. Notes. Summary effect size (◇); Imputed study (●); Summary effect size of imputed studies (◆); Individual studies (○).
Figure 5
Figure 5
Difference in means of office systolic blood pressure changes by nurse-coordinated intervention. Notes. Point estimate of individual study (●); Summary effect size (◆); SBP, systolic blood pressure; UC, usual care; NC-HBPT, nurse-coordinated home blood pressure telemonitoring.
Figure 6
Figure 6
Difference in means of office systolic blood pressure changes over time. Notes. Point estimate of individual study (●); Subgroup (○); Summary effect size (◆); DBP, diastolic blood pressure; UC, usual care; NC-HBPT, nurse-coordinated home blood pressure telemonitoring.
Figure 7
Figure 7
Difference in means of office diastolic blood pressure changes by nurse-coordinated intervention. Notes. Point estimate of individual study (●); Summary effect size (◆); DBP, diastolic blood pressure; UC, usual care; NC-HBPT, nurse-coordinated home blood pressure telemonitoring.
Figure 8
Figure 8
Difference in means of office diastolic blood pressure changes over time. Notes. Summary effect size (◆); Point estimate of individual study (●); Subgroup (○); UC, usual care; NC-HBPT, nurse-coordinated home blood pressure telemonitoring.
See this image and copyright information in PMC

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