Italian Institute of Telemedicine, Varese, Italy.
Am J Hypertens. 2011 Sep;24(9):989-98. doi: 10.1038/ajh.2011.100. Epub 2011 Jun 9.
Home blood pressure telemonitoring figures among the possible solutions that could help improve blood pressure control of hypertensive patients. To summarize the effectiveness of home blood pressure telemonitoring on blood pressure control from randomized, controlled studies.
Electronic databases were searched for publications in English, reporting on randomized trials of home blood pressure telemonitoring vs. usual care. Outcome measures were office or ambulatory blood pressure changes, rate of blood pressure control, and number of antihypertensive drugs used by patients. A random effects model was applied.
Twelve studies met inclusion criteria. A high level of heterogeneity was found among studies for all the variables explored. Office blood pressure was reduced significantly more in patients randomized to home telemonitoring (systolic: 5.64 (95% confidence interval: 7.92, 3.36) mm Hg; diastolic: 2.78 (3.93, 1.62) mm Hg; 11 comparisons, n = 4,389). The effect on ambulatory blood pressure was smaller than on office blood pressure (systolic: 2.28 (4.32, 0.24); diastolic: 1.38 (3.55, +0.79) mm Hg; 3 comparisons, n = 655). The relative risk of blood pressure normalization (<140/90 mm Hg nondiabetics and <130/80 mm Hg diabetics) in the telemonitoring vs. the usual care group was 1.31 (1.06, 1.62) (5 comparisons, n = 2,432 subjects). Use of telemonitoring was associated with a significantly increased use of antihypertensive medications (+0.22 (+0.02, +0.43), 5 comparisons, n = 1,991).
Home blood pressure telemonitoring may represent a useful tool to improve blood pressure control. However, heterogeneity of published studies suggests that well designed, large-scale, randomized, controlled studies are still needed to demonstrate the clinical usefulness of this technique.
家庭血压远程监测是改善高血压患者血压控制的可能解决方案之一。本研究旨在综述随机对照试验中家庭血压远程监测对血压控制效果的相关研究。
检索电子数据库，寻找发表于英文期刊、关于家庭血压远程监测与常规护理比较的随机对照试验。观察指标为诊室或动态血压变化、血压控制率以及患者降压药物使用数量。采用随机效应模型进行分析。
共有 12 项研究符合纳入标准。所有纳入研究之间存在高度异质性。与常规护理组相比，远程监测组的诊室收缩压（5.64mmHg，95%置信区间：7.92，3.36）和舒张压（2.78mmHg，3.93，1.62）降低更显著（11 项研究，n=4389）。远程监测组的动态血压变化虽小于诊室血压变化，但仍具有统计学意义（收缩压：2.28mmHg，4.32，0.24；舒张压：1.38mmHg，3.55，+0.79）（3 项研究，n=655）。远程监测组血压正常化（非糖尿病患者<140/90mmHg，糖尿病患者<130/80mmHg）的相对风险为 1.31（1.06，1.62）（5 项研究，n=2432）。与常规护理组相比，远程监测组降压药物使用数量显著增加（+0.22，95%置信区间：0.02，0.43）（5 项研究，n=1991）。
家庭血压远程监测可能是一种改善血压控制的有效手段。然而，由于纳入研究的异质性，仍需要开展设计良好、规模较大的随机对照试验来验证该技术的临床应用价值。
