Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies

Abstract

To summarise evidence about the effectiveness of home blood pressure telemonitoring (HBPT) and identify the key components of intervention. We comprehensively searched PubMed, EMBASE and the Cochrane Library for relevant studies. The authors were contacted for additional information. Two authors independently extracted the data and assessed the risk of bias. 46 randomised controlled trials including a total of 13 875 cases were identified. Compared with usual care, HBPT improved office systolic blood pressure (BP) and diastolic BP by 3.99 mm Hg (95% confidence interval (CI): 5.06–2.93; P<0.001) and 1.99 mm Hg (95% CI: −2.60 to −1.39; P<0.001), respectively. A larger proportion of patients achieved BP normalisation in the intervention group (relative risk (RR): 1.16; 95% CI: 1.08–1.25; P<0.001). For HBPT plus additional support (including counselling, education, behavioural management, medication management with decision, adherence contracts and so on) versus HBPT alone (or plus less intense additional support), the mean changes in systolic and diastolic BP were 2.44 mm Hg (95% Cl, 4.88 to 0.00 mm Hg; P=0.05) and 1.12 mm Hg (95% CI, −2.34 to 0.1 mm Hg; P=0.07), respectively. For those surrogate outcomes, low-strength evidence failed to show difference. In subgroup analysis, high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel. HBPT can improve BP control in the hypertensive patients. It may be more efficacious when a proactive additional support is provided during the intervention process.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4

References

  1. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D . Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the american heart association, american society of hypertension, and preventive cardiovascular nurses association. Hypertension 2008; 52: 10–29.

    CAS  Article  Google Scholar 

  2. Bosworth HB, Powers BJ, Olsen MK, McCant F, Grubber J, Smith V et al. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Arch Intern Med 2011; 171: 1173–1180.

    Article  Google Scholar 

  3. Green BB, Anderson ML, Cook AJ, Catz S, Fishman PA, McClure JB et al. E-care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk. Am J Prev Med 2014; 46: 368–377.

    Article  Google Scholar 

  4. McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S et al. Telemonitoring and self-management in the control of hypertension (tasminh2): a randomised controlled trial. Lancet 2010; 376: 163–172.

    Article  Google Scholar 

  5. McManus RJ, Mant J, Haque MS, Bray EP, Bryan S, Greenfield SM et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the tasmin-sr randomized clinical trial. JAMA 2014; 312: 799–808.

    CAS  Article  Google Scholar 

  6. Parati G, Omboni S . Role of home blood pressure telemonitoring in hypertension management: an update. Blood Press Monit 2010; 15: 285–295.

    Article  Google Scholar 

  7. Kim YN, Shin DG, Park S, Lee CH . Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure. Hypertens Res 2015; 38: 491–497.

    Article  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. PLos Med 2009; 6: e1000097.

    Article  Google Scholar 

  9. Higgins J, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 (updated March 2011). The Cochrane Collaboration: London, England, 2011.

  10. Artinian NT, Flack JM, Nordstrom CK, Hockman EM, Washington OG, Jen KL et al. Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban african americans. Nurs Res 2007; 56: 312–322.

    Article  Google Scholar 

  11. Artinian NT, Washington OGM, Templin TN . Effects of home telemonitoring and community-based monitoring on blood pressure control in urban african americans: a pilot study. Heart Lung 2001; 30: 191–199.

    CAS  Article  Google Scholar 

  12. Bond GE, Burr R, Wolf FM, Price M, McCurry SM, Teri L . The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial. Diabetes Technol Ther 2007; 9: 52–59.

    Article  Google Scholar 

  13. Bove AA, Homko CJ, Santamore WP, Kashem M, Kerper M, Elliott DJ . Managing hypertension in urban underserved subjects using telemedicine—a clinical trial. Am Heart J 2013; 165: 615–621.

    Article  Google Scholar 

  14. Bowen ME, Bosworth HB, Roumie CL . Blood pressure control in a hypertension telemedicine intervention: Does distance to primary care matter? J Clin Hypertens (Greenwich) 2013; 15: 723–730.

    Google Scholar 

  15. Carrasco MP, Salvador CH, Sagredo PG, Marquez-Montes J, Gonzalez DMM, Fragua JA et al. Impact of patient-general practitioner short-messages-based interaction on the control of hypertension in a follow-up service for low-to-medium risk hypertensive patients: a randomized controlled trial. IEEE Trans Inf Technol Biomed 2008; 12: 780–791.

    Article  Google Scholar 

  16. Earle KA, Istepanian RS, Zitouni K, Sungoor A, Tang B . Mobile telemonitoring for achieving tighter targets of blood pressure control in patients with complicated diabetes: a pilot study. Diabetes Technol Ther 2010; 12: 575–579.

    Article  Google Scholar 

  17. Friedman RH, Kazis LE, Jette A, Smith MB, Stollerman J, Torgerson J et al. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. Am J Hypertens 1996; 9: 285–292.

    CAS  Article  Google Scholar 

  18. Goulis DG, Giaglis GD, Boren SA, Lekka I, Bontis E, Balas EA et al. Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial. Int J Obes Relat Metab Disord 2004; 28: 1391–1398.

    CAS  Article  Google Scholar 

  19. Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J et al. Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008; 299: 2857–2867.

    CAS  Article  Google Scholar 

  20. Hageman PA, Pullen CH, Hertzog M, Boeckner LS . Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the wellness for women: dashing towards health clinical trial. Int J Behav Nutr Phys Act 2014; 11: 148.

    Article  Google Scholar 

  21. Kraschnewski JL, Stuckey HL . Efficacy of a weight-loss website based on positive deviance. A randomized trial. Am J Prev Med 2011; 41: 610–614.

    Article  Google Scholar 

  22. Madsen LB, Kirkegaard P, Pedersen EB . Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months. Blood Press 2008; 17: 78–86.

    Article  Google Scholar 

  23. Magid DJ, Ho PM, Olson KL, Brand DW, Welch LK, Snow KE et al. A multimodal blood pressure control intervention in 3 healthcare systems. Am J Manag Care 2011; 17: e96–e103.

    PubMed  Google Scholar 

  24. Magid DJ, Olson KL, Billups SJ, Wagner NM, Lyons EE, Kroner BA . A pharmacist-led, american heart association heart360 web-enabled home blood pressure monitoring program. Circ Cardiovasc Qual Outcomes 2013; 6: 157–163.

    Article  Google Scholar 

  25. Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Groen SE, Kadrmas HM et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA 2013; 310: 46–56.

    CAS  Article  Google Scholar 

  26. Mcdoniel SO, Wolskee P, Shen J . Treating obesity with a novel hand-held device, computer software program, and internet technology in primary care: the smart motivational trial. Patient Educ Couns 2010; 79: 185–191.

    Article  Google Scholar 

  27. McKinstry B, Hanley J, Wild S, Pagliari C, Paterson M, Lewis S et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMJ 2013; 346: f3030.

    Article  Google Scholar 

  28. Mcmahon GT, Gomes HE, Sara HH, Tang Ming-Jye H, Levine BA, Conlin PR . Web-based care management in patients with poorly controlled diabetes. Diabetes Care 2005; 28: 1624–1629.

    Article  Google Scholar 

  29. Park MJ, Kim HS, Kim KS . Cellular phone and internet-based individual intervention on blood pressure and obesity in obese patients with hypertension. Int J Med Inform 2009; 78: 704–710.

    Article  Google Scholar 

  30. Kim MT, Kim EY, Han HR, Jeong S, Lee JE, Park HJ et al. Mail education is as effective as in-class education in hypertensive korean patients. J Clin Hypertens (Greenwich) 2008; 10: 176–184.

    Article  Google Scholar 

  31. Parati G, Omboni S, Albini F, Piantoni L, Giuliano A, Revera M et al. Home blood pressure telemonitoring improves hypertension control in general practice. The telebpcare study. J Hypertens 2009; 27: 198–203.

    CAS  Article  Google Scholar 

  32. Park MJ, Kim HS . Evaluation of mobile phone and internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesity. Int J Med Inform 2012; 81: 388–394.

    Article  Google Scholar 

  33. Pezzin LE, Feldman PH, Mongoven JM, McDonald MV, Gerber LM, Peng TR . Improving blood pressure control: Results of home-based post-acute care interventions. J Gen Intern Med 2011; 26: 280–286.

    Article  Google Scholar 

  34. Piette JD, Datwani H, Gaudioso S, Foster SM, Westphal J, Perry W et al. Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries. Telemed J E Health 2012; 18: 613–620.

    Article  Google Scholar 

  35. Rifkin DE, Abdelmalek JA, Miracle CM, Low C, Barsotti R, Rios P et al. Linking clinic and home: a randomized, controlled clinical effectiveness trial of real-time, wireless blood pressure monitoring for older patients with kidney disease and hypertension. Blood Press Monit 2013; 18: 8–15.

    Article  Google Scholar 

  36. Rinfret S, Lussier MT, Peirce A, Duhamel F, Cossette S, Lalonde L et al. The impact of a multidisciplinary information technology-supported program on blood pressure control in primary care. Circ Cardiovasc Qual Outcomes 2009; 2: 170–177.

    Article  Google Scholar 

  37. Istepanian RSH, Sungoor A, Earle KA . Technical and compliance considerations for mobile health self-monitoring of glucose and blood pressure for patients with diabetes. Conf Proc IEEE Eng Med Biol Soc 2009; 2009: 5130–5133.

  38. Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, Cimino JJ et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the ideatel study. J Am Med Inform Assoc 2009; 16: 446–456.

    Article  Google Scholar 

  39. Soghikian K, Casper SM, Fireman BH, Hunkeler EM, Hurley LB, Tekawa IS et al. Home blood pressure monitoring. Effect on use of medical services and medical care costs. Med Care 1992; 30: 855–865.

    CAS  Article  Google Scholar 

  40. Varis J, Kantola I . The choice of home blood pressure result reporting method is essential: results mailed to physicians did not improve hypertension control compared with ordinary office-based blood pressure treatment. Blood Press 2010; 19: 319–324.

    Article  Google Scholar 

  41. Yi SS, Tabaei BP, Angell SY, Rapin A, Buck MD, Pagano WG et al. Self-blood pressure monitoring in an urban, ethnically diverse population: a randomized clinical trial utilizing the electronic health record. Circ Cardiovasc Qual Outcomes 2015; 8: 138–145.

    Article  Google Scholar 

  42. Yoo HJ, Park MS, Kim TN, Yang SJ, Cho GJ, Hwang TG et al. A ubiquitous chronic disease care system using cellular phones and the internet. Diabet Med 2009; 26: 628–635.

    CAS  Article  Google Scholar 

  43. Wakefield BJ, Holman JE, Ray A, Scherubel M, Adams MR, Hillis SL et al. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Telemed J E Health 2011; 17: 254–261.

    Article  Google Scholar 

  44. Neumann CL, Menne J, Rieken EM, Fischer N, Weber MH, Haller H et al. Blood pressure telemonitoring is useful to achieve blood pressure control in inadequately treated patients with arterial hypertension. J Hum Hypertens 2011; 25: 732–738.

    CAS  Article  Google Scholar 

  45. Hanley J, Fairbrother P, Krishan A, McCloughan L, Padfield P, Paterson M et al. Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (tia). Trials 2015; 16: 117.

    Article  Google Scholar 

  46. Rogers MA, Small D, Buchan DA, Butch CA, Stewart CM, Krenzer BE et al. Home monitoring service improves mean arterial pressure in patients with essential hypertension. Ann Intern Med 2001; 134: 1024–1032.

    CAS  Article  Google Scholar 

  47. Logan AG, Irvine MJ, Mcisaac WJ, Tisler A, Rossos PG, Easty A et al. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension 2012; 60: 51–57.

    CAS  Article  Google Scholar 

  48. Wakefield BJ, Holman JE, Ray A, Scherubel M, Adams MR, Hillis SL et al. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Telemed J E Health 2011; 17: 254–261.

    Article  Google Scholar 

  49. Thiboutot J, Sciamanna CN, Falkner B, Kephart DK, Stuckey HL, Adelman AM et al. Effects of a web-based patient activation intervention to overcome clinical inertia on blood pressure control: cluster randomized controlled trial. J Med Internet Res 2013; 15: e158–e158.

    Article  Google Scholar 

  50. Madsen LB, Kirkegaard P, Pedersen EB . Health-related quality of life (sf-36) during telemonitoring of home blood pressure in hypertensive patients: a randomized, controlled study. Blood Press 2008; 17: 227–232.

    Article  Google Scholar 

  51. Omboni S, Gazzola T, Carabelli G, Parati G . Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens 2013; 31: 455–467 discussion 467-458.

    CAS  Article  Google Scholar 

  52. Verberk WJ, Kessels AG, Thien T . Telecare is a valuable tool for hypertension management, a systematic review and meta-analysis. Blood Press Monit 2011; 16: 149–155.

    Article  Google Scholar 

  53. Márquezcontreras E . Efficacy of a home blood pressure monitoring programme on therapeutic compliance in hypertension: the eapacum-hta study. J Hypertens 2006; 24: 169–175.

    Article  Google Scholar 

  54. Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C . Ambulatory blood pressure and mortality: a population-based study. Hypertension 2005; 45: 499–504.

    CAS  Article  Google Scholar 

  55. Liu S, Dunford SD, Leung YW, Brooks D, Thomas SG, Eysenbach G et al. Reducing blood pressure with internet-based interventions: a meta-analysis. Can J Cardiol 2013; 29: 613–621.

    CAS  Article  Google Scholar 

  56. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L . Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension 2011; 58: 950–958.

    CAS  Article  Google Scholar 

  57. Nolan RP, Liu S, Payne AY . E-counseling as an emerging preventive strategy for hypertension. Curr Opin Cardiol 2014; 29: 319–323.

    Article  Google Scholar 

  58. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM . Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med 2013; 159: 185–194.

    Article  Google Scholar 

Download references

Acknowledgements

The study was funded by grants from Municipal Science Foundation Grants of Guangzhou, China (2013Y2-00130) and Health Collaborative Innovation Major projects of Guangzhou, China (201508020253).

Author contributions

Zhiquan Xie had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design by Xie and Duan. Acquisition of data by Sun and Xu. Selection and Statistical analysis of data by Duan and Lin. Quality assessment by Dong and Wu. Arbitrators by Xie and Wu. Drafting of the manuscript by Duan and Xie. Administrative, technical or material support by Xie and Duan. Supervision by Xie.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Z Xie.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on the Journal of Human Hypertension website .

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Duan, Y., Xie, Z., Dong, F. et al. Effectiveness of home blood pressure telemonitoring: a systematic review and meta-analysis of randomised controlled studies. J Hum Hypertens 31, 427–437 (2017). https://doi.org/10.1038/jhh.2016.99

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.99

Further reading

Search

Quick links