远程医疗对中风后患者血压管理的有效性和依从性：随机对照试验的系统评价和荟萃分析

Effectiveness and compliance of telemedicine on blood pressure management in poststroke patients: a systematic review and meta-analysis of randomised controlled trials.

作者信息

Yang Yulin, Xu Hongli, Chang Wanpeng, Li Chenying, Cao Pengyu

机构信息

The Cardiovascular Center, The Affiliated Changzhou No 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China.

Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China.

出版信息

BMJ Open. 2024 Dec 23;14(12):e083461. doi: 10.1136/bmjopen-2023-083461.

DOI:10.1136/bmjopen-2023-083461

PMID:39719284

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11667429/

Abstract

OBJECTIVE

To examine the effectiveness of telemedicine on blood pressure control and compliance.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A search of PubMed, Web of Science, Embase and Cochrane Library for studies of randomised controlled trials (RCTs) of telemedicine on blood pressure control in poststroke survivors from the time of their construction until November 2023. Inclusion criteria were as follows: (1) studies that were RCTs; (2) enrolment of patients who were stroke survivors; (3) studies that compared subjects who received telemedicine with usual care treatment. Exclusion criteria were as follows: (1) studies in which telemedicine was used for other diseases; (2) study protocols with no data; (3) non-English language articles and (4) case reports, conference papers, letters or articles with incomplete data. Quality assessment of included studies was performed using the Cochrane Risk of Bias Tool.

PRIMARY OUTCOME MEASURES

The primary outcomes was the systolic blood pressure (SBP) (mm Hg), diastolic blood pressure (DBP) (mm Hg), patient compliance and the proportion of patients achieving target blood pressure.

RESULTS

A total of 11 studies with 2903 patients were included in this paper. There were 1453 cases in the telemedicine group and 1450 cases in the usual care group. Meta-analysis showed a statistically significant decrease in SBP (mm Hg) in the telemedicine group compared with the usual care group at weeks 3, 6 and 12 of follow-up (week 3: mean difference (MD), -8.8; 95% CI, -12.05 to -5.56; p<0.00001; week 6: MD, -5.13; 95% CI, -8.07 to -2.18; p=0.0007; week 12: MD, -2.78; 95% CI, -4.68 to -0.89; p=0.004). At week 12 of follow-up, there was a statistically significant decrease in DBP (mm Hg) in the telemedicine group compared with the usual care group (MD, -1.57; 95% CI, -2.59 to -0.55; p=0.003). In addition, patient compliance was better in the telemedicine group than in the usual care group (OR, 1.61; 95% CI, 1.29 to 2.01; p<0.0001), and the proportion of patients achieving target blood pressure was higher than in the usual care group (OR, 3.49; 95% CI, 2.64 to 4.63; p<0.00001).

CONCLUSIONS

Compared with usual care, telemedicine interventions can better improve blood pressure control in poststroke survivors and increase patient compliance.

TRIAL REGISTRATION NUMBER

CRD42022382001.

摘要

目的

探讨远程医疗对血压控制及依从性的效果。

设计

系统评价与荟萃分析。

数据来源

检索PubMed、科学网、Embase和Cochrane图书馆，查找自建库至2023年11月关于远程医疗对卒中后幸存者血压控制的随机对照试验（RCT）研究。纳入标准如下：（1）RCT研究；（2）纳入卒中幸存者患者；（3）比较接受远程医疗与常规护理治疗的受试者的研究。排除标准如下：（1）将远程医疗用于其他疾病的研究；（2）无数据的研究方案；（3）非英文文章；（4）病例报告、会议论文、信函或数据不完整的文章。使用Cochrane偏倚风险工具对纳入研究进行质量评估。

主要结局指标

主要结局为收缩压（SBP）（mmHg）、舒张压（DBP）（mmHg）、患者依从性以及达到目标血压的患者比例。

结果

本文共纳入11项研究，涉及2903例患者。远程医疗组1453例，常规护理组1450例。荟萃分析显示，随访第3、6和12周时，远程医疗组的SBP（mmHg）较常规护理组有统计学意义的下降（第3周：平均差（MD），-8.8；95%置信区间（CI），-12.05至-5.56；p<0.00001；第6周：MD，-5.13；95%CI，-8.07至-2.18；p=0.0007；第12周：MD，-2.78；95%CI，-4.68至-0.89；p=0.004）。随访第12周时，远程医疗组的DBP（mmHg）较常规护理组有统计学意义的下降（MD，-1.57；95%CI，-2.59至-0.55；p=0.003）。此外，远程医疗组的患者依从性优于常规护理组（比值比（OR），1.61；95%CI，1.29至2.01；p<0.0001），达到目标血压的患者比例高于常规护理组（OR，3.49；95%CI，2.64至4.63；p<0.00001）。