Telemonitoring and self-management for digital hypertension management: is there a preferred method?

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.