Telemedical strategies for improving systolic blood pressure control in secondary prevention of cerebrovascular events-a systematic review and meta-analysis

• Published in: Journal of stroke and cerebrovascular diseases 2024-12, Vol.33 (12), p.108046, Article 108046
• Main Authors: Munir, Aqsa, Farooqi, Hanzala Ahmed, Nabi, Rayyan, Hasnain, Ummulkiram, Khan, Marium
• Format: Article
• Language: English
• Subjects: Aged; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Cerebrovascular event; Female; Humans; Hypertension - complications; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - mortality; Hypertension - physiopathology; Male; Middle Aged; Observational Studies as Topic; Prevention; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Risk Reduction Behavior; Secondary Prevention; Stroke; Stroke - diagnosis; Stroke - mortality; Stroke - physiopathology; Stroke - prevention & control; Systole; Telemedicine; Telephone; Time Factors; Treatment Outcome
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2024.108046

Stroke remains the second leading cause of death worldwide, with a 20 % risk of recurrence within 5 years. Preventing secondary stroke events is crucial for patient management. Kraft et al. highlighted the potential of telemedicine in secondary prevention, but noted the need for further research. Our study incorporates recent trials to provide an updated analysis of telemedical strategies in stroke prevention. We reviewed and analyzed RCTs and observational studies from PubMed, Cochrane, Google Scholar, and Clinicaltrials.gov (May 19, 2016 - March 20, 2024) comparing telephone-based follow-up to standard care in stroke patients. The meta-analysis focused on SBP changes within 12 months. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, sourced from PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov (May 19, 2016 – March 20, 2024). We compared telephone-based follow-up to standard care in stroke patients, and the primary outcome was systolic blood pressure (SBP) changes within 12 months. Our systematic review included data from 21,904 patients. The meta-analysis focused on studies with comparable systolic blood pressure (SBP) data. It involved 3,501 individuals in the control group and 3,485 in the experimental group. The analysis revealed a significant reduction in SBP with telemedicine strategies for secondary stroke prevention, with a p-value of 0.003. Additionally, a systemic review of the included studies demonstrated that these strategies improved medication adherence, lifestyle habits, and physical performance, positively correlating with better health outcomes and reduced mortality risk. With the inclusion of recent clinical trials, our updated systematic review and meta-analysis concludes that telemedicine supports secondary prevention in cerebrovascular diseases, particularly blood pressure control. While telemedicine may have a role in reducing recurrent stroke risk, we believe further studies with longer follow-up periods are needed to validate the role of telemedical strategies in reducing recurrence rates.