Muneer Shezel, Okpechi Ikechi G, Ye Feng, Zaidi Deenaz, Tinwala Mohammed M, Hamonic Laura N, Ghimire Anukul, Sultana Naima, Slabu Dan, Khan Maryam, Braam Branko, Jindal Kailash, Klarenbach Scott, Padwal Raj, Ringrose Jennifer, Scott-Douglas Nairne, Shojai Soroush, Thompson Stephanie, Bello Aminu K
Department of Medicine, University of Alberta, Edmonton, Canada.
John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada.
Can J Kidney Health Dis. 2022 Jun 21;9:20543581221106248. doi: 10.1177/20543581221106248. eCollection 2022.
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.
To determine the impact of HBPT on cardiovascular-related and kidney disease-related outcomes in patients with CKD.
Systematic review and meta-analysis.
All studies that met our criteria regardless of country of origin.
Patients with chronic kidney disease included in studies using HBPT for BP assessment and control.
Descriptive and quantitative analysis of our primary and secondary outcomes.
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).
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).
Heterogeneity and few available studies for inclusion limited our ability to identify a robust link between HBPT use and BP and kidney function improvement.
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.
.
高血压是心血管疾病、慢性肾脏病（CKD）及死亡的主要原因。多项研究已证实家庭血压远程监测（HBPT）对血压（BP）控制及预后的有效性，但该干预措施对CKD患者的影响仍不明确。
确定HBPT对CKD患者心血管相关及肾脏疾病相关预后的影响。
系统评价和荟萃分析。
所有符合我们标准的研究，无论其原产国。
使用HBPT进行血压评估和控制的研究中纳入的慢性肾脏病患者。
对主要和次要结局进行描述性和定量分析。
我们检索了MEDLINE、Embase、CINAHL Plus、PsycINFO、Cochrane CENTRAL、Web of Science以及自数据库建立以来的灰色文献，以查找在非透析（ND）CKD中使用HBPT进行血压控制的观察性和随机对照研究。我们选择了在ND-CKD人群中使用HBPT作为干预措施（有或无对照臂）进行血压控制的研究。主要结局是平均收缩压（SBP）和平均舒张压（DBP）的变化。
我们从最初识别的1669篇文章中筛选出7项研究。总体而言，SBP和DBP的平均差值（MD）合并估计值分别为-8.8 mmHg；95%置信区间（CI）：-16.2至-1.4；P = 0.02和-2.4 mmHg；95%CI：-3.8至-1.0；P < 0.001。对于比较干预与常规护理（UC）的研究，SBP的MD合并估计值为-8.0 mmHg（P = 0.02），DBP无显著降低（-2.6 mmHg；P = 0.18）。在没有UC臂的研究中，SBP和DBP均未显著降低（P > 0.05）。估计肾小球滤过率的MD合并估计值显示有显著改善（5.4 mL/min/1.73 m²；P < 0.001）。
异质性以及可供纳入的研究较少，限制了我们确定使用HBPT与血压及肾功能改善之间有力关联的能力。
家庭血压远程监测与CKD患者血压轻度降低及肾功能适度改善相关。然而，仍需要设计更好、干预时间更长的更大规模研究来评估HBPT对患者预后的影响。
PROSPERO注册号：.
