{"id":"09f3db6043df","type":"article","url":"https://hartvaat.nl/2024/03/01/thuisbloeddruk-geleide-farmacotherapie-via-telezorg-meta-analyse-van-vs-trials/","title":"Thuisbloeddruk-geleide farmacotherapie via telezorg: meta-analyse van VS-trials","title_en":"Self-Measured Blood Pressure-Guided Pharmacotherapy: A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","thuisbloeddrukmeting"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.22109","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.22109","authors":["Sameer Acharya","Gagan Neupane","Austin Seals","Madhav Kc","Dean Giustini","Sharan Sharma","Yhenneko J Taylor","Deepak Palakshappa","Jeff D Williamson","Justin B Moore","Hayden B Bosworth","Yashashwi Pokharel"],"significance":6,"published":"2024-03-01","source_date":"2024-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This meta-analysis of US-based telehealth trials confirmed that self-measured blood pressure-guided pharmacotherapy significantly improves blood pressure control compared with usual care, supporting the implementation of telemedicine hypertension management.","created":"2026-07-03T10:30:48Z","updated":"2026-07-03T18:39:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van Amerikaanse telezorgtrials bevestigde dat thuisbloeddruk-geleide farmacotherapie de bloeddrukcontrole significant verbetert. Telezorg is een effectief model voor hypertensiemanagement in de eerstelijn.","abstract_original":"BACKGROUND: The optimal approach to implementing telemedicine hypertension management in the United States is unknown. METHODS: We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials]. RESULTS: Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials. CONCLUSIONS: Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation."}