The Effectiveness of Telemedicine in Hypertension Management of Adults in Rural Communities: A Systematic Review and Meta-Analysis.

Background: Telemedicine has emerged as an effective approach for managing hypertension, particularly in rural areas where healthcare access is limited. This review evaluates telemedicine's role in providing essential remote healthcare services for hypertension management.

Objective: We determined the effectiveness of telemedicine versus the usual care in hypertension management among adults living in rural settings.

Methods: We conducted a systematic review of randomized controlled trials (RCTs) focusing on adults aged 18 and older with hypertension (blood pressure ≥ 140/90 mmHg) using telehealth services in rural or community-based settings. We searched nine databases, including PubMed, ScienceDirect, and ProQuest, up to April 2024, without restrictions on language or publication year, focusing only on human subjects. Five pairs of reviewers independently screened and selected studies using predefined eligibility criteria. Methodological quality was assessed using the Revised Cochrane Collaboration Risk of Bias tool, and data synthesis was performed using a random-effects model due to study heterogeneity. Evidence quality was evaluated using the GRADE approach.

Results: Nine randomized trials were included. Pooled data showed no clinically significant differences between telehealth and control groups in improving systolic blood pressure (SBP), diastolic blood pressure (DBP), and their changes over time. The mean difference (MD) of SBP in five trials was 0.78 mmHg lower (95% CI: 2.49 lower to 0.94 higher), and the SBP change showed a mean reduction of 2.29 mmHg (95% CI: 4.76 lower to 0.19 higher). DBP in five trials had a mean increase of 0.46 mmHg (95% CI: 0.73 lower to 1.64 higher), and DBP change in six trials showed a mean decrease of 0.83 mmHg (95% CI: 2.34 lower to 0.68 higher). Additionally, telehealth showed varying impacts on BMI and HbA1c levels, with one study reporting a higher BMI increase in the intervention group, while two other studies indicated that mobile health improved HbA1c levels and controlled blood pressure as effectively as standard care.

Limitations: Study heterogeneity, selection, and performance biases, as well as varying healthcare contexts, limited the generalizability of findings.

Conclusion: Telemedicine is as effective as usual care in managing hypertension among adults in rural settings, providing a viable solution for improving healthcare access in these areas. Future research should address biases and explore long-term impacts to optimize telemedicine's effectiveness in diverse populations.