School of Nursing, Gansu University of Chinese Medicine, Lanzhou, PR China.
Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, PR China.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107928. doi: 10.1016/j.jstrokecerebrovasdis.2024.107928. Epub 2024 Aug 24.
Stroke is a common cerebrovascular disease. Elevated blood pressure is the most significant manageable factor for both initial and recurrent strokes. Despite the potential benefits of telemedicine and mobile health technology (mHealth) in managing blood pressure among stroke patients, there remains skepticism.
This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effectiveness of telemedicine and mHealth interventions in managing blood pressure in stroke patients.
We identified randomized controlled trials (RCTs) evaluating telemedicine and mHealth technology interventions for blood pressure in patients with stroke or transient ischemic attack (TIA) from the inception date of each database up to January 2, 2024 by systematic searches of the PubMed, EMBASE, Web of Science, and Cochrane Library databases. The Cochrane Risk of Bias tool (ROB 2.0) was used to evaluate study quality. Sources of heterogeneity were explored through Meta-regression, subgroup analyses, sensitivity analyses and publication bias assessment. Meta-analysis was performed using R 4.2.2 statistical software.
A total of 13 randomized controlled trials with 3803 participants were included. The meta-analysis found that telemedicine and mHealth improved control of both systolic [MD = -4.37, 95 % CI (-5.50, -3.24), I = 43 %, P<0.00001] and diastolic blood pressures [MD = -1.72, 95 % CI (-2.45, -0.98), I = 0 %, P<0.00001] in stroke patients compared to the conventional care group. Stroke patients who received telemedicine and mHealth interventions showed improved medication adherence than usual care [SMD=0.52, 95 % CI (0.03, 1.00), I = 90 %, P<0.00001]. Meta-regression and subgroup analyses identified several key factors influencing systolic and diastolic blood pressure control in stroke patients, including whether stroke patients have hypertension, the specific forms of telemedicine and mHealth interventions employed, the duration of these interventions, and the frequency of intervention intervals.
Overall, telemedicine and mHealth reduced stroke patients' systolic blood pressure by an average of 4.37 mm Hg and diastolic blood pressure by an average of 1.72 mm Hg and improved medication adherence compared with usual care. As an emerging medical model, telemedicine and mHealth intervention create a good prospect for the management of blood pressure in stroke patients in the future.
中风是一种常见的脑血管疾病。高血压是初发和复发中风最重要的可控制因素。尽管远程医疗和移动健康技术（mHealth）在管理中风患者血压方面具有潜在益处，但仍存在质疑。
本系统评价和随机对照试验（RCT）的荟萃分析旨在评估远程医疗和 mHealth 干预措施在管理中风患者血压方面的有效性。
我们从每个数据库的创建日期到 2024 年 1 月 2 日，通过系统搜索 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆数据库，确定了评估远程医疗和 mHealth 技术干预中风或短暂性脑缺血发作（TIA）患者血压的随机对照试验（RCT）。使用 Cochrane 偏倚风险工具（ROB 2.0）评估研究质量。通过 Meta 回归、亚组分析、敏感性分析和发表偏倚评估探索异质性来源。使用 R 4.2.2 统计软件进行荟萃分析。
共有 13 项随机对照试验，3803 名参与者纳入研究。荟萃分析发现，与常规护理组相比，远程医疗和 mHealth 改善了中风患者的收缩压[MD=-4.37，95%CI（-5.50，-3.24），I=43%，P<0.00001]和舒张压[MD=-1.72，95%CI（-2.45，-0.98），I=0%，P<0.00001]的控制。接受远程医疗和 mHealth 干预的中风患者比常规护理组显示出更好的药物依从性[SMD=0.52，95%CI（0.03，1.00），I=90%，P<0.00001]。Meta 回归和亚组分析确定了影响中风患者收缩压和舒张压控制的几个关键因素，包括中风患者是否患有高血压、所采用的远程医疗和 mHealth 干预的具体形式、这些干预的持续时间以及干预间隔的频率。
总的来说，与常规护理相比，远程医疗和 mHealth 平均降低了中风患者的收缩压 4.37mmHg，舒张压 1.72mmHg，并提高了药物依从性。作为一种新兴的医疗模式，远程医疗和 mHealth 干预为未来中风患者的血压管理创造了良好的前景。
