Introduction: Telehealth (TH) that uses telecommunications (e.g. Internet, landline, or mobile phone) as a method to provide healthcare remotely is used to improve hypertension (HTN) control. However, the effectiveness of TH on HTN control among disparate populations is unclear.
Methods: We conducted a systematic review and meta-analyses using the Cochrane methodology. The Healthy People 2020 social determinants of health were used to define disparate populations. Multiple databases were searched for publications from January 2000-July 2017. Inclusion criteria noted disparate populations, telehealth, and hypertension. No restrictions were made for sample size, location, or language due to lack of available data on disparate populations. Non-English studies were translated in English. Outcomes were: 1) systolic blood pressure (SBP) or diastolic blood pressure (DBP) change, 2) goal blood pressure (BP), 3) medication adherence, and 4) continuity of care (CoC) by same healthcare provider or team. Descriptive analysis and subgroup meta-analyses were conducted as appropriate.
Results: After screening 1997 items, 22 primary studies were included (14 RCTs, 3 non-RCTs, and 5 pre-post studies). Sample size at baseline was 22,372 (range: 12-5,851). Studies reported disparate populations by social and community context (100.0%), health and health care (52.4%), economic stability (42.9%), and education (23.8%). Interventions included telemonitoring (90.5%), and/or self-management education (76.2%). In six months or less the pooled effect of five studies demonstrated a significantly larger SBP and DBP reduction in the TH group with CoC compared to usual care (UC) [mean difference in mmHg (95% confidence interval (CI)): SBP: -8.02 (-15.34 to -0.69); DBP: -4.32 ( -8.29 to -0.35)]. Also, the pooled effect of four studies for SBP and three studies for DBP in 6.1-24 months showed a significantly larger reduction of BP in the TH group compared to usual care (UC) [mean difference in mmHg (95% CI): SBP: -2.70 (-3.37 to -2.03); DBP: -2.01 (-2.43 to -1.59)]. Nine of the 22 studies reported goal BP as an outcome. Four of five RCTs were among those nine studies that reported improvement in the TH group achieving goal BP compared to UC. Seven studies reported medication adherence as an outcome, including four RCTs. Only one RCT reported significant medication adherence improvement in the TH group compared to UC (p<0.05).
Conclusion: Telehealth shows promise to improve HTN control in disparate populations. Continuity of care with TH reduced SBP and DBP and thus may prevent associated serious complications. These results may inform healthcare providers, health plans, and decision makers about the benefit of using TH to improve HTN control among disparate populations.