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Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic
Shezel Muneer1, Ikechi G Okpechi1, Feng Ye1
1Department of Medicine, University of Alberta, Edmonton, Canada.
Insights
Home blood pressure telemonitoring (HBPT) moderately lowers blood pressure and improves kidney function in patients with chronic kidney disease (CKD). Further research is needed to confirm these benefits and assess long-term outcomes.
Area of Science:
- Nephrology and Hypertension Research
- Cardiovascular Disease Management
- Telehealth and Digital Health Interventions
Background:
- Hypertension is a significant risk factor for cardiovascular disease, chronic kidney disease (CKD), and mortality.
- Home blood pressure telemonitoring (HBPT) has shown promise in blood pressure (BP) management, but its impact on CKD patients is not well-established.
Purpose of the Study:
- To evaluate the effects of HBPT on cardiovascular and kidney-related outcomes in patients diagnosed with CKD.
Main Methods:
- A systematic review and meta-analysis were conducted, searching multiple databases for relevant observational and randomized controlled studies.
- Included studies focused on non-dialysis (ND) CKD patients using HBPT for BP assessment and control.
- Primary outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP); secondary outcomes included estimated glomerular filtration rate (eGFR).
Main Results:
- Seven studies were included, revealing a pooled mean difference of -8.8 mm Hg for SBP and -2.4 mm Hg for DBP.
- In studies comparing HBPT with usual care, SBP significantly decreased (-8.0 mm Hg), but DBP did not show a significant reduction.
- A significant improvement in eGFR was observed (5.4 mL/min/1.73 m²).
Conclusions:
- HBPT is associated with a mild reduction in BP and a moderate improvement in kidney function among CKD patients.
- Limitations include study heterogeneity and a limited number of available studies.
- Larger, well-designed studies with longer follow-up periods are necessary to definitively assess HBPT's impact on patient outcomes.
Background:
Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of home blood pressure telemonitoring (HBPT) for blood pressure (BP) control and outcomes, but the effects of this intervention remain unclear in patients with CKD.
Objective:
To determine the impact of HBPT on cardiovascular-related and kidney disease-related outcomes in patients with CKD.
Design:
Systematic review and meta-analysis.
Setting:
All studies that met our criteria regardless of country of origin.
Participants:
Patients with chronic kidney disease included in studies using HBPT for BP assessment and control.
Measurements:
Descriptive and quantitative analysis of our primary and secondary outcomes.
Methods:
We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and gray literature from inception for observational and randomized controlled studies in nondialysis (ND) CKD using HBPT for BP control. We selected studies that used HBPT as intervention (with or without a control arm) for BP control in ND-CKD populations. The primary outcome was change in mean systolic BP (SBP) and mean diastolic BP (DBP).
Results:
We selected 7 studies from 1669 articles that were initially identified. Overall, pooled estimates in the mean difference (MD) for SBP and DBP were -8.8 mm Hg; 95% confidence interval (CI): -16.2 to -1.4; P = .02 and -2.4 mm Hg; 95% CI: -3.8 to -1.0; P < .001, respectively. For studies comparing intervention with usual care (UC), pooled estimate in MD for SBP was -8.0 mm Hg (P = .02) with no significant reduction for DBP (-2.6 mm Hg; P = .18). In studies without a UC arm, both SBP and DBP were not significantly reduced (P > .05). The pooled estimate in MD for estimated glomerular filtration rate showed a significant improvement (5.4 mL/min/1.73 m2; P < .001).
Limitations:
Heterogeneity and few available studies for inclusion limited our ability to identify a robust link between HBPT use and BP and kidney function improvement.
Conclusion:
Home blood pressure telemonitoring is associated with mild lowering of BP and moderately improved kidney function in patients with CKD. However, larger studies with improved designs and prolonged interventions are still needed to assess the effects of HBPT on patients' outcomes.
Prospero Registration Id:
CRD42020190705.
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