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 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; = .02 and -2.4 mm Hg; 95% CI: -3.8 to -1.0; < .001, respectively. For studies comparing intervention with usual care (UC), pooled estimate in MD for SBP was -8.0 mm Hg ( = .02) with no significant reduction for DBP (-2.6 mm Hg; = .18). In studies without a UC arm, both SBP and DBP were not significantly reduced ( > .05). The pooled estimate in MD for estimated glomerular filtration rate showed a significant improvement (5.4 mL/min/1.73 m; < .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

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