Postel-Vinay Nicolas, Asmar Roland, Steichen Olivier
Assistance Publique Hôpitaux de Paris, Hypertension Unit, European Georges Pompidou Hospital, Paris, France.
Research Department, Foundation-Medical Research Institutes (F-MRI), Geneva, Switzerland.
Mhealth. 2025 Jul 11;11:40. doi: 10.21037/mhealth-24-104. eCollection 2025.
Given the rise of telemonitoring and self-management, experts debate the respective advantages and disadvantages of these two approaches. To date, no study has directly compared the efficiency or cost-effectiveness of blood pressure (BP) telemonitoring initiated and supervised by healthcare professionals (HCPs) and self-management of patients autonomously following a prespecified plan, but both have been compared to standard in-office BP management. A 2017 meta-analysis showed that telemonitoring leads to faster BP reduction and a higher rate of patients reaching their BP target than standard care. A 2023 meta-analysis found that digital health intervention to assist patients, such as short message services (SMS), smartphone apps, and websites, led to a larger BP decrease compared to usual care but the high variability in study designs and potential biases temper these results. Currently, the evidence supporting self-management for BP control is less compelling than for telemonitoring. But clinical trials may not fully reflect real-world scenarios. Economic evaluations have not clearly shown that telemonitoring is more cost-effective than standard care. In some studies, healthcare costs were even higher in the telemonitoring group, although this must be weighed against the benefits. On the opposite, some digital self-management tools do not collect identifiable user information, therefore face fewer regulatory constraints, and finally are less costly. Telemonitoring requires significant involvement and time to devote from HCPs to manage data and respond to alerts, raising concerns about increased workload. On the opposite, self-management telemonitoring reduces the workload for HCPs because patients manage their own BP readings and interactions with digital tools autonomously. Another critical aspect to consider is the relationship between patients and HCPs, which differs greatly between telemonitoring and self-management. However, we still lack a full understanding of patient and HCP expectations regarding autonomy and monitoring. The 2023 European Society of Hypertension (ESH) guidelines now endorse digital interventions and self-titration algorithms. There are many differences between self-managing and telemonitoring to claim that one is superior to the other. A more constructive approach is to explore how they can complement each other.
鉴于远程监测和自我管理的兴起，专家们对这两种方法各自的优缺点展开了辩论。迄今为止，尚无研究直接比较由医疗保健专业人员（HCP）发起和监督的血压（BP）远程监测与患者按照预先指定计划自主进行自我管理的效率或成本效益，但两者均已与标准的诊室血压管理进行了比较。一项2017年的荟萃分析表明，与标准护理相比，远程监测可使血压降低得更快，且达到血压目标的患者比例更高。一项2023年的荟萃分析发现，与常规护理相比，诸如短信服务（SMS）、智能手机应用程序和网站等协助患者的数字健康干预措施可使血压有更大幅度的下降，但研究设计的高度变异性和潜在偏差削弱了这些结果。目前，支持自我管理以控制血压的证据不如支持远程监测的证据有说服力。但临床试验可能无法完全反映现实世界的情况。经济评估并未明确表明远程监测比标准护理更具成本效益。在一些研究中，远程监测组的医疗保健成本甚至更高，尽管必须权衡其益处。相反，一些数字自我管理工具不收集可识别的用户信息，因此面临的监管限制较少，最终成本也较低。远程监测需要HCP投入大量精力和时间来管理数据并响应警报，这引发了对工作量增加的担忧。相反，自我管理远程监测减轻了HCP的工作量，因为患者可以自主管理自己的血压读数以及与数字工具的交互。另一个需要考虑的关键方面是患者与HCP之间的关系，这在远程监测和自我管理之间有很大差异。然而，我们仍然缺乏对患者和HCP在自主性和监测方面期望的全面理解。2023年欧洲高血压学会（ESH）指南现在认可数字干预措施和自我滴定算法。自我管理和远程监测之间存在许多差异，以至于无法宣称一方优于另一方。一种更具建设性的方法是探索它们如何相互补充。
