Is telehealth the optimal strategy for hypertension follow-up? A network meta-analysis of randomized controlled trials
P Pajareya, N Pitiariyanun, S Yenruedee, J Kittithammo, T Samantarath, T Sakpetch, A Varama, N SiranartAbstract
Background
Telehealth interventions for blood pressure (BP) monitoring and counseling have been increasingly utilized to enhance follow-up care and long-term management in patients with hypertension. However, the comparative effectiveness of different types of telehealth feature combinations remains unclear.
Purpose
To evaluate the impact of different telehealth feature combinations on BP control, medication adherence, and changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) across intervention strategies in patients with hypertension during 1-year follow-up.
Methods
A systematic review of randomized controlled trials (RCTs) evaluating telehealth monitoring and counseling interventions for adults with hypertension was conducted. Interventions were classified according to core digital health intervention (DHI) features: Tracking (T; blood pressure and vital sign logging with data visualization), Notify (N; medication or activity reminders and behavioral coaching), Remote (R; clinician data access and teleconsultation), and Educate (E; structured educational content on hypertension management). Intervention combinations included T, N, R, E, TN, TR, TE, NE, TNR, TNE, TRE, NRE, TNRE. Standard care (SC) was used as the reference comparator. The primary outcome was controlled BP. Secondary outcomes included medication adherence and changes in SBP and DBP.
Results
A total of 40 RCTs involving 11,644 patients were included (3 T, 1 N, 2 E, 4 TN, 1 TR, 2 TE, 3 NE, 7 TNR, 12 TNE, 1 TRE, 6 TNRE, and 36 SC). Overall, interventions incorporating a greater number of telehealth features demonstrated superior effectiveness compared with standard care (SC). For BP control, TNRE showed the highest odds of achieving control (OR 2.97; 95%CI 1.77–4.98), followed by TRE (OR 2.70; 95% CI 1.05–6.94). Two-component and single-component interventions demonstrated comparatively smaller effects. Regarding medication adherence, TNE ranked first with the highest P-score (0.834), followed by TRE (0.726) and NRE (0.712), with two-component and single-component interventions showing lower rankings. For SBP reduction, TNRE (MD −3.69 mmHg; 95%CI −7.00 to −0.38) and TNE (MD −3.83 mmHg; 95%CI −6.84 to −0.81) were associated with significant reductions compared with SC. Reductions in DBP were modest and comparable across interventions, without statistically significant differences versus SC.
Conclusion
Telehealth interventions incorporating multiple digital features, particularly those including Tracking (T; vital sign logging with data visualization) and Education (E; structured hypertension management content) are associated with greater improvements in blood pressure control among patients with hypertension. Interventions with a higher number of integrated features demonstrated superior effectiveness compared with simpler approaches. Telehealth platforms may represent an effective strategy for hypertension control and long-term follow-up.Figure 1Figure 2