Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis
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...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-06-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581221106248 |
| _version_ | 1818236019939475456 |
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| author | Shezel Muneer Ikechi G. Okpechi Feng Ye Deenaz Zaidi Mohammed M. Tinwala Laura N. Hamonic Anukul Ghimire Naima Sultana Dan Slabu Maryam Khan Branko Braam Kailash Jindal Scott Klarenbach Raj Padwal Jennifer Ringrose Nairne Scott-Douglas Soroush Shojai Stephanie Thompson Aminu K. Bello |
| author_facet | Shezel Muneer Ikechi G. Okpechi Feng Ye Deenaz Zaidi Mohammed M. Tinwala Laura N. Hamonic Anukul Ghimire Naima Sultana Dan Slabu Maryam Khan Branko Braam Kailash Jindal Scott Klarenbach Raj Padwal Jennifer Ringrose Nairne Scott-Douglas Soroush Shojai Stephanie Thompson Aminu K. Bello |
| author_sort | Shezel Muneer |
| collection | DOAJ |
| description | 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 m 2 ; 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 |
| first_indexed | 2024-12-12T12:03:13Z |
| format | Article |
| id | doaj.art-e7478914c8d64e61b67921f8059cc270 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-12-12T12:03:13Z |
| publishDate | 2022-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-e7478914c8d64e61b67921f8059cc2702022-12-22T00:25:03ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812022-06-01910.1177/20543581221106248Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-AnalysisShezel Muneer0Ikechi G. Okpechi1Feng Ye2Deenaz Zaidi3Mohammed M. Tinwala4Laura N. Hamonic5Anukul Ghimire6Naima Sultana7Dan Slabu8Maryam Khan9Branko Braam10Kailash Jindal11Scott Klarenbach12Raj Padwal13Jennifer Ringrose14Nairne Scott-Douglas15Soroush Shojai16Stephanie Thompson17Aminu K. Bello18Department of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaJohn W. Scott Health Sciences Library, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaFaculty of Science, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDepartment of Medicine, University of Alberta, Edmonton, CanadaDivision of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, CanadaBackground: 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 m 2 ; 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 CRD42020190705https://doi.org/10.1177/20543581221106248 |
| spellingShingle | Shezel Muneer Ikechi G. Okpechi Feng Ye Deenaz Zaidi Mohammed M. Tinwala Laura N. Hamonic Anukul Ghimire Naima Sultana Dan Slabu Maryam Khan Branko Braam Kailash Jindal Scott Klarenbach Raj Padwal Jennifer Ringrose Nairne Scott-Douglas Soroush Shojai Stephanie Thompson Aminu K. Bello Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis Canadian Journal of Kidney Health and Disease |
| title | Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis |
| title_full | Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis |
| title_fullStr | Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis |
| title_short | Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis |
| title_sort | impact of home telemonitoring and management support on blood pressure control in nondialysis ckd a systematic review and meta analysis |
| url | https://doi.org/10.1177/20543581221106248 |
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