Clinical Decision Support Systems Using Home Blood Pressure Readings to Manage Patients With Hypertension: Scoping Review.

backgroundHome blood pressure (HBP) is an important parameter that guides clinicians in managing hypertension in patients. However, in using these records to manage patients, physicians face challenges, particularly regarding access, integration, and interpretation of the records when making clinical decisions. Clinical decision support systems (CDSSs) have been proposed to address these challenges; however, current literature reveals significant heterogeneity and gaps in CDSSs used for hypertension management.

objectiveThis study aimed to summarize existing studies on CDSSs that use HBP readings to manage patients with hypertension.

methodsWe conducted a scoping review, with searches performed in PubMed, Embase, and Scopus on April 1, 2024. The results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Studies that used CDSSs integrated with HBP monitoring among adult patients with hypertension in outpatient settings were included. Non-English studies were excluded. Outcomes assessed included the theoretical frameworks used for CDSS development, CDSS components (data capture, processing, and output), clinical outcomes, user experiences, and implementation processes.

resultsOf the 5023 articles screened, 33 (0.66%) were included. Most of the studies were conducted in the United States (16/33, 49%) and were randomized controlled trials (21/33, 64%). Nearly two-thirds of the CDSSs (21/33, 64%) were computerized. Only 1 (3%) of the 33 studies reported using a theoretical framework for CDSS development. HBP recording and uploading were predominantly automatic (23/33, 70%). All computerized CDSSs (21/33, 64%) used rule-based algorithms, and most (19/21, 91%) incorporated alert triggers for results outside the reference range. More than a third of the studies (13/33, 39%) were based on hypertension guidelines. Among studies that reported outcomes, most reported improved blood pressure (25/29, 86%) and adjustment in antihypertensive medications (16/19, 84%). Patients and clinicians appreciated the convenience and remote monitoring (10/33, 30%) but reported challenges with usability and access to computerized CDSSs (2/21, 10%). Of the studies using noncomputerized CDSSs (12/33, 36%), all incorporated patient education, while nearly two-thirds of the studies using computerized CDSSs (13/21, 62%) did the same. Clinician training was reported in 5% (1/21) of the computerized CDSSs and 25% (3/12) of the noncomputerized CDSSs.

conclusionsWhile CDSSs hold promise for improving hypertension management, gaps remain in their development and implementation. Future efforts should focus on integrating robust frameworks; aligning with guidelines; enhancing manual data integration; and addressing usability to maximize effectiveness, adoption, and user satisfaction.

trial registrationOpen Science Framework 26zmn; https://osf.io/26zmn.