In recent years, the integration of mobile health (m-Health) interventions has garnered increasing attention as a potential means to improve blood pressure (BP) management in adults. This updated systematic review with meta-analysis aimed to identify the effect of m-Health-based interventions on BP in adults and to evaluate the effect of m-Health on BP according to the characteristics of subjects, interventions, and countries.
Methods:
The search was carried out in PubMed, Embase, ResearchGate, and Cochrane databases in January 2022. Study selection and data extraction were performed by two independent reviewers. For analysis, random effects models were used with a confidence interval (CI) of 95% and p < 0.05.
Results:
Fifty studies were included in this review and in the meta-analysis. Interventions with m-Health reduced systolic BP in 3.5 mmHg (95% CI −4.3; −2.7; p < 0.001; I2 = 85.8%) and diastolic BP in 1.8 mmHg (95% CI −2.3; −1.4; p < 0.001; I2 = 78.9%) compared to usual care. The effects of m-Health interventions on BP were more evident in men and in older adults, in interventions lasting 6–8 weeks, with medication reminders, with the possibility of insertion of BP values (p < 0.05).
Conclusion:
The results of this study support the effectiveness of m-Health in reducing BP when compared to standard care. However, these effects are dependent on the characteristics of the subjects and interventions. Given the substantial heterogeneity among the results of this systematic review with meta-analysis, its interpretation should be cautious. Future research on this topic is warranted.
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References
1.
MaltaDC, PinheiroPC, AzeredoRT, et al.Prevalência de alto risco cardiovascular na população adulta brasileira segundo diferentes critérios: Estudo comparativo. Cien Saude Colet, 2021; 26:1221–1231.
2.
LoboLAC, CanutoR, Dias-da-CostaJS, et al.Tendência temporal da prevalência de hipertensão arterial sistêmica no Brasil. Cad Saude Publica, 2017; 33:e00035316.
3.
BhandariB, NarasimhanP, JayasuriyaR, et al.Effectiveness and acceptability of a mobile phone text messaging intervention to improve blood pressure control (TEXT4BP) among patients with hypertension in Nepal: A feasibility randomised controlled trial. Glob Heart, 2022; 17(1).
4.
KassavouA, WangM, MirzaeiV, et al.The Association Between Smartphone App–Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth, 2022; 10(7):e34767; doi: 10.2196/34767
5.
BozorgiA, HosseiniH, EftekharH, et al.The effect of the mobile “blood pressure management application” on hypertension self-management enhancement: A randomized controlled trial. Trials, 2021; 22(1):413.
6.
NaharP, KannuriNK, MikkilineniS, et al.mHealth and the management of chronic conditions in rural areas: A note of caution from southern India. Anthropol Med, 2017; 24(1):1–16.
7.
MarcolinoMS, OliveiraJAQ, D’AgostinoM, et al.The impact of mhealth interventions: Systematic review of systematic reviews. JMIR Mhealth Uhealth, 2018; 6(1):e23; doi: 10.2196/mhealth.8873
8.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg, 2021; 88:105906.
9.
MaoY, LinW, WenJ, et al.Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: A systematic review and meta-analysis. BMJ Open Diabetes Res Care, 2020; 8(1):e001225.
10.
CarvalhoAPV, SilvaV. GA. Avaliação do risco de viés de ensaios clínicos randomizados pela ferramenta da colaboração Cochrane. Diagnóstico & Tratamento, 2013; 18(1).
11.
BasudevN, Crosby‐NwaobiR, ThomasS, et al.A prospective randomized controlled study of a virtual clinic integrating primary and specialist care for patients with type 2 diabetes mellitus. Diabet Med, 2016; 33(6):768–776.
12.
BobrowK, FarmerAJ, SpringerD, et al.Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-Text Adherence Support [StAR]) a single-blind, randomized trial. Circulation, 2016; 133(6):592–600.
13.
Bujnowska-FedakMM, PuchałaE, SteciwkoA. The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. Telemed J E Health , 2011; 17(3):153–163.
14.
ChoJH, KimH-S, YooSH, et al.An Internet-based health gateway device for interactive communication and automatic data uploading: Clinical efficacy for type 2 diabetes in a multi-centre trial. J Telemed Telecare, 2017; 23(6):595–604.
15.
CrowleyMJ, EdelmanD, McAndrewAT, et al.Practical telemedicine for veterans with persistently poor diabetes control: A randomized pilot trial. Telemed J E Health , 2016; 22(5):376–384.
16.
DavisRM, HitchAD, SalaamMM, et al.TeleHealth improves diabetes self-management in an underserved community: Diabetes TeleCare. Diabetes Care, 2010; 33(8):1712–1717; doi: 10.2337/dc09-1919
17.
DebonR, BelleiEA, BiduskiD, et al.Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy. Sci Rep, 2020; 10(1):6009.
18.
DorschMP, CornellierML, PoggiAD, et al.Effects of a novel contextual just-in-time mobile app intervention (LowSalt4Life) on sodium intake in adults with hypertension: Pilot randomized controlled trial. JMIR Mhealth Uhealth, 2020; 8(8):e16696.
19.
FortmannAL, GalloLC, GarciaMI, et al.Dulce Digital: An mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 2017; 40(10):1349–1355.
20.
EgedeLE, DawsonAZ, WalkerRJ, et al.Randomized controlled trial of technology-assisted case management in low-income adults with type 2 diabetes: Effect on quality of life and blood pressure. J Telemed Telecare, 2021; 30(1):107–115.
21.
GongK, YanY-L, LiY, et al.Mobile health applications for the management of primary hypertension: A multicenter, randomized, controlled trial. Medicine (Baltimore), 2020; 99(16):e19715; doi: 10.1097/MD.0000000000019715
22.
GreenBB, CookAJ, RalstonJD, et al.Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: A randomized controlled trial. JAMA, 2008; 299(24):2857–2867.
23.
IonovMV, ZhukovaOV, YudinaYS, et al.Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients. Blood Press, 2021; 30(1):20–30.
24.
JahanY, RahmanMM, FaruqueASG, et al.Awareness development and usage of mobile health technology among individuals with hypertension in a rural community of Bangladesh: Randomized controlled trial. J Med Internet Res, 2020; 22(12):e19137.
25.
JiaW, ZhangP, ZhuD, et al.Evaluation of an mHealth-enabled hierarchical diabetes management intervention in primary care in China (ROADMAP): A cluster randomized trial. PLoS Med, 2021; 18(9):e1003754.
26.
KempfK, AltpeterB, BergerJ, et al.Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: A randomized controlled trial. Diabetes Care, 2017; 40(7):863–871.
27.
KimY-N, ShinDG, ParkS, et al.Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure. Hypertens Res, 2015; 38(7):491–497.
28.
KimJY, WineingerNE, SteinhublSR. The influence of wireless self-monitoring program on the relationship between patient activation and health behaviors, medication adherence, and blood pressure levels in hypertensive patients: A substudy of a randomized controlled trial. J Med Internet Res, 2016; 18(6):e116.
29.
LeeJY, ChanCKY, ChuaSS, et al.Telemonitoring and team-based management of glycemic control on people with type 2 diabetes: A cluster-randomized controlled trial. J Gen Intern Med, 2020; 35(1):87–94.
30.
LeeM-K, LeeDY, AhnH-Y, et al.A novel user utility score for diabetes management using tailored mobile coaching: Secondary analysis of a randomized controlled trial. JMIR Mhealth Uhealth, 2021; 9(2):e17573.
31.
LeeP, LiuJ-C, HsiehM-H, et al.Cloud-based BP system integrated with CPOE improves self-management of the hypertensive patients: A randomized controlled trial. Comput Methods Programs Biomed, 2016; 176:237–238.
32.
LimS, KangSM, KimKM, et al.Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes. Acta Diabetol, 2016; 53(2):189–198.
33.
LimSL, OngKW, JohalJ, et al.Effect of a smartphone app on weight change and metabolic outcomes in Asian adults with type 2 diabetes: A randomized clinical trial. JAMA Netw Open, 2021; 4(6):e2112417–e2112417.
34.
LiouJ-K, SoonM-S, ChenC-H, et al.Shared care combined with telecare improves glycemic control of diabetic patients in a rural underserved community. Telemed J E Health , 2014; 20(2):175–178.
35.
MargolisKL, AscheSE, BergdallAR, et al.Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 2013; 310(1):46–56.
36.
McManusRJ, MantJ, FranssenM, et al.Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): An unmasked randomised controlled trial. Lancet, 2018; 391(10124):949–959.
37.
McManusRJ, MantJ, BrayEP, et al.Telemonitoring and self-management in the control of hypertension (TASMINH2): A randomised controlled trial. Lancet, 2010; 376(9736):163–172.
38.
McManusRJ, LittleP, StuartB, et al.Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: Randomised controlled trial. BMJ, 2021; 372:m4858.
39.
MengWW, BaiYY, LiYAN, et al.Effect of Home Blood Pressure Telemonitoring Plus Additional Support on Blood Pressure Control: A Randomized Clinical Trial. Biomed Environ Sci, 2023; 36(6):517–526.
40.
NicolucciA, CerconeS, ChiriattiA, et al.A randomized trial on home telemonitoring for the management of metabolic and cardiovascular risk in patients with type 2 diabetes. Diabetes Technol Ther, 2015; 17(8):563–570.
41.
OdnoletkovaI, GoderisG, NobelsF, et al.Optimizing diabetes control in people with type 2 diabetes through nurse‐led telecoaching. Diabet Med, 2016; 33(6):777–785.
42.
PietteJD, RichardsonC, HimleJ, et al.A randomized trial of telephone counseling plus walking for depressed diabetes patients. Med Care, 2011; 49(7):641–648.
43.
PietteJD, DatwaniH, GaudiosoS, 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(8):613–620.
44.
RifkinDE, AbdelmalekJA, MiracleCM, 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(1):8–15.
45.
RichesSP, PiernasC, AveyardP, et al.A mobile health salt reduction intervention for people with hypertension: Results of a feasibility randomized controlled trial. JMIR Mhealth Uhealth, 2021; 9(10):e26233.
46.
RodriguezMA, WangB, HyoungS, et al.Sustained benefit of alternate behavioral interventions to improve hypertension control: A randomized clinical trial. Hypertension, 2021; 77(6):1867–1876.
47.
RossiMCE, NicolucciA, Di BartoloP, et al.Diabetes Interactive Diary: A new telemedicine system enabling flexible diet and insulin therapy while improving quality of life: An open-label, international, multicenter, randomized study. Diabetes Care, 2010; 33(1):109–115.
48.
SchoenthalerA, LeonM, ButlerM, et al.Development and evaluation of a tailored mobile health intervention to improve medication adherence in black patients with uncontrolled hypertension and type 2 diabetes: Pilot randomized feasibility trial. JMIR Mhealth Uhealth, 2020; 8(9):e17135.
49.
SheaS, WeinstockRS, TeresiJA, 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(4):446–456.
50.
SunY-Q, JiaY-P, LvJ-Y, et al.The clinical effects of a new management mode for hypertensive patients: A randomized controlled trial. Cardiovasc Diagn Ther, 2020; 10(6):1805–1815.
51.
TangPC, OverhageJM, ChanAS, et al.Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc, 2013; 20(3):526–534.
52.
WildSH, HanleyJ, LewisSC, et al.Supported telemonitoring and glycemic control in people with type 2 diabetes: The telescot diabetes pragmatic multicenter randomized controlled trial. PLoS Med, 2016; 13(7):e1002098.
53.
VaughanEM, HymanDJ, NaikAD, et al.AT elehealth-supported, I ntegrated care with CHWs, and ME dication-access (TIME) Program for Diabetes Improves HbA1c: A Randomized Clinical Trial. J Gen Intern Med, 2021; 36(2):455–463.
54.
LeeDY, YooS-H, MinKP, et al.Effect of voluntary participation on mobile health care in diabetes management: Randomized controlled open-label trial. JMIR Mhealth Uhealth, 2020; 8(9):e19153.
55.
YutingZ, XiaodongT, QunW. Effectiveness of a mHealth intervention on hypertension control in a low-resource rural setting: A randomized clinical trial. Front Public Health, 2023; 11:1049396.
56.
ZhaP, QureshiR, PorterS, et al.Utilizing a mobile health intervention to manage hypertension in an underserved community. West J Nurs Res, 2020; 42(3):201–209.
57.
ZhangY, TaoY, ZhongY, et al.Feedback based on health advice via tracing bracelet and smartphone in the management of blood pressure among hypertensive patients: A community-based RCT trial in Chongqing, China. Medicine (Baltimore), 2022; 101(28):e29346.
58.
ZhouP, XuL, LiuX, et al.Web-based telemedicine for management of type 2 diabetes through glucose uploads: A randomized controlled trial. Int J Clin Exp Pathol, 2014; 7(12):8848.
59.
ZhouH, WangX, YangY, et al.Effect of a Multicomponent Intervention Delivered on a Web-Based Platform on Hypertension Control: A Cluster Randomized Clinical Trial. JAMA Netw Open, 2022; 5(12):e2245439–e2245439.
60.
HaluzaD, WernhartA. Does gender matter? Exploring perceptions regarding health technologies among employees and students at a medical university. Int J Med Inform, 2019; 130:103948.
61.
WongAKC, WongFKY, ChowKKS, et al.Effect of a Mobile Health Application With Nurse Support on Quality of Life Among Community-Dwelling Older Adults in Hong Kong: A Randomized Clinical Trial. JAMA Netw Open, 2022; 5(11):e2241137–e2241137.
62.
LiR, LiangN, BuF, et al.The effectiveness of self-management of hypertension in adults using mobile health: Systematic review and meta-analysis. JMIR Mhealth Uhealth, 2020; 8(3):e17776.
63.
PeirisD, PraveenD, JohnsonC, et al.Use of mHealth systems and tools for non-communicable diseases in low-and middle-income countries: A systematic review. J Cardiovasc Transl Res, 2014; 7:677–691.
64.
NieuwlaatR, SchwalmJ-D, KhatibR, et al.Why are we failing to implement effective therapies in cardiovascular disease? Eur Heart J, 2013; 34(17):1262–1269.
65.
OgedegbeG, Plange-RhuleJ, GyamfiJ, et al.A cluster-randomized trial of task shifting and blood pressure control in Ghana: Study protocol. Implementation Sci, 2014; 9(1):1–10.
66.
RamachandranA, SnehalathaC, RamJ, et al.Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol, 2013; 1(3):191–198.
67.
CaoW, MilksMW, LiuX, et al.mHealth Interventions for self-management of hypertension: Framework and systematic review on engagement, interactivity, and tailoring. JMIR Mhealth Uhealth, 2022; 10(3):e29415.
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