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Research Article | Volume 30 Issue 5 (May, 2025) | Pages 45 - 48
Comparative Study on the Effectiveness of Telemedicine vs In-Person Consultations in Managing Hypertension during the Post-COVID Era
 ,
 ,
1
Junior Resident, Department of Pharmacology, GMERS Medical College, Himmatnagar, Gujarat, India
2
Junior Resident, Department of Paediatrics, GMERS Medical College, Vadnagar, Gujarat, India
Under a Creative Commons license
Open Access
Received
March 22, 2025
Revised
April 23, 2025
Accepted
May 1, 2025
Published
May 15, 2025
Abstract

Background: The COVID-19 pandemic significantly accelerated the adoption of telemedicine worldwide, especially for managing chronic diseases like hypertension. With the easing of pandemic-related restrictions, a comparative evaluation of the effectiveness of telemedicine versus traditional in-person consultations is essential to optimize long-term hypertension management strategies. Materials and Methods: A prospective, comparative study was conducted at a tertiary care center. A total of 200 patients diagnosed with primary hypertension were enrolled and randomized into two groups: Group A (n=100) received telemedicine consultations via video/audio calls every month, while Group B (n=100) attended in-person visits on the same schedule. Both groups received lifestyle counseling and medication adjustments based on their blood pressure (BP) readings. Data on systolic and diastolic BP, medication adherence (using the Morisky scale), and patient satisfaction (using a 5-point Likert scale) were collected at baseline and after 6 months. Results: At the end of the study period, Group A showed a mean reduction of 12.5 mmHg in systolic BP and 8.2 mmHg in diastolic BP, while Group B showed a reduction of 13.1 mmHg and 8.5 mmHg respectively. There was no statistically significant difference in BP control between the groups (p > 0.05). Medication adherence was slightly higher in the telemedicine group (mean Morisky score: 7.8 ± 1.1) compared to the in-person group (7.4 ± 1.3), though not statistically significant. Patient satisfaction was higher in the telemedicine group (mean score: 4.6/5) due to convenience and time-saving benefits. Conclusion: Telemedicine consultations were found to be as effective as in-person visits in managing hypertension in the post-COVID era, with comparable outcomes in BP control and adherence, and higher patient satisfaction. These findings support the integration of telehealth as a sustainable model for chronic disease management.

Keywords
INTRODUCTION

Hypertension remains one of the most significant public health challenges worldwide, affecting over 1.28 billion adults globally and contributing substantially to cardiovascular morbidity and mortality (1). Effective management of hypertension requires consistent follow-up, medication adherence, and lifestyle modifications, which traditionally have been facilitated through in-person clinical consultations (2). However, the COVID-19 pandemic imposed unprecedented constraints on physical healthcare access, prompting a rapid shift toward digital healthcare platforms, including telemedicine (3).

 

Telemedicine, defined as the remote delivery of healthcare services using telecommunications technology, has demonstrated potential in improving access to care, reducing healthcare costs, and maintaining continuity of care, especially during health emergencies (4). In the context of hypertension, previous studies have reported that virtual consultations can achieve outcomes comparable to traditional care in terms of blood pressure control and patient compliance (5,6). However, concerns persist regarding the adequacy of physical examination, digital literacy among patients, and long-term sustainability of virtual care models (7).

 

With the transition into the post-COVID era, the healthcare system faces a pivotal moment to evaluate the effectiveness of telemedicine in comparison to conventional in-person consultations for chronic disease management. Although several studies conducted during the pandemic have suggested positive outcomes with telehealth, there is a scarcity of comparative data assessing its performance under normalized healthcare conditions (8). This study aims to fill this gap by comparing the effectiveness of telemedicine and in-person consultations in managing hypertension, specifically focusing on blood pressure control, medication adherence, and patient satisfaction.

MATERIALS AND METHODS

A total of 200 patients aged between 30 and 65 years, diagnosed with primary hypertension and on antihypertensive therapy for at least six months, were recruited. Patients were randomly allocated into two equal groups using a computer-generated randomization sequence. Group A (n = 100) received telemedicine-based follow-up via video or audio consultations, while Group B (n = 100) attended traditional face-to-face consultations at the hospital. Exclusion criteria included secondary hypertension, pregnancy, cognitive impairment, and lack of access to a smartphone or internet connection.

 

Both groups were followed monthly for a duration of six months. During each follow-up, blood pressure readings were recorded. Patients in Group A self-monitored their blood pressure at home using validated digital sphygmomanometers, and readings were shared during teleconsultations. Group B had their blood pressure measured in the clinic by trained healthcare staff using a standard mercury sphygmomanometer.

 

In both groups, treatment plans were adjusted as per standard hypertension management guidelines. Medication adherence was assessed at baseline and after 6 months using the Morisky Medication Adherence Scale (MMAS-8). Patient satisfaction was measured at the end of the study using a 5-point Likert scale questionnaire focusing on convenience, communication, and overall satisfaction with the mode of consultation.

 

All data were compiled and statistically analyzed using SPSS version 25. Continuous variables were presented as means ± standard deviation and compared using the independent t-test. Categorical variables were analyzed using the chi-square test. A p-value of less than 0.05 was considered statistically significant.

 

RESULTS

A total of 200 patients participated in the study, with 100 patients in each group. Both groups were comparable in terms of demographic characteristics such as age, gender distribution, and baseline blood pressure readings (Table 1).

 

After six months of follow-up, both groups showed significant improvements in systolic and diastolic blood pressure levels. Group A (telemedicine) demonstrated a mean reduction in systolic blood pressure of 12.5 ± 7.4 mmHg and diastolic pressure of 8.2 ± 5.1 mmHg. Group B (in-person) exhibited a slightly greater mean reduction in systolic pressure of 13.1 ± 6.9 mmHg and diastolic pressure of 8.5 ± 4.8 mmHg; however, the intergroup difference was not statistically significant (p > 0.05) (Table 2).

 

Medication adherence, assessed by the MMAS-8 scale, improved in both groups. The mean score in Group A increased from 6.3 ± 1.5 at baseline to 7.8 ± 1.1 at the end of the study. In Group B, the adherence score increased from 6.1 ± 1.6 to 7.4 ± 1.3. Although the telemedicine group showed marginally higher adherence, the difference was not statistically significant (p = 0.07) (Table 3).

 

Patient satisfaction was notably higher in the telemedicine group. A majority of participants in Group A (78%) reported a satisfaction score of 4 or higher on the 5-point Likert scale, compared to 62% in Group B. Factors contributing to higher satisfaction in Group A included reduced travel time, ease of appointment scheduling, and convenience of follow-up (Table 4).

 

Table 1. Baseline Characteristics of Study Participants

Parameter

Group A (Telemedicine)

Group B (In-person)

p-value

Mean Age (years)

52.4 ± 9.2

53.1 ± 8.8

0.56

Male (%)

58

60

0.74

Female (%)

42

40

0.74

Baseline SBP (mmHg)

148.3 ± 10.6

149.1 ± 11.2

0.61

Baseline DBP (mmHg)

91.2 ± 7.4

90.8 ± 7.9

0.68

 

Table 2. Change in Blood Pressure after 6 Month

Parameter

Group A (Telemedicine)

Group B (In-person)

p-value

SBP Reduction (mmHg)

12.5 ± 7.4

13.1 ± 6.9

0.47

DBP Reduction (mmHg)

8.2 ± 5.1

8.5 ± 4.8

0.61

 

Table 3. Medication Adherence (MMAS-8 Score)

Time Point

Group A (Telemedicine)

Group B (In-person)

p-value

Baseline

6.3 ± 1.5

6.1 ± 1.6

0.44

After 6 Months

7.8 ± 1.1

7.4 ± 1.3

0.07

 

Table 4. Patient Satisfaction Scores

Satisfaction Score (out of 5)

Group A (%)

Group B (%)

1–2

4

9

3

18

29

4

42

36

5

36

26

As shown in Tables 2–4, both modes of care delivery were effective in managing hypertension, but telemedicine demonstrated a slight advantage in terms of patient satisfaction and adherence.

DISCUSSION

The present study demonstrates that telemedicine is as effective as in-person consultations for the management of hypertension in the post-COVID era. Both intervention arms showed comparable reductions in systolic and diastolic blood pressure, with no statistically significant difference, aligning with earlier research that supports virtual platforms as viable alternatives to conventional healthcare delivery (1,2). This reinforces the growing evidence that telemedicine can facilitate chronic disease management by ensuring continuity of care, particularly in non-acute settings (3).

 

One of the critical findings in this study is the improvement in medication adherence in both groups, with a slightly higher, though not statistically significant, adherence observed in the telemedicine group. This observation supports the hypothesis that virtual consultations may empower patients through more frequent engagement, greater convenience, and reduced logistical burdens, all of which contribute to improved compliance (4-6).

 

In terms of patient satisfaction, telemedicine outperformed in-person consultations, likely due to its user-centered advantages such as reduced travel, decreased waiting times, and flexibility in scheduling (7,8). Several studies have found that patients value convenience highly, particularly those with mobility issues or residing in remote areas (9,10). While concerns have been raised about the impersonality of virtual care and the inability to perform physical examinations, our results suggest that for hypertension—where management is primarily data-driven—such limitations have minimal clinical impact (11).

 

The findings also resonate with post-pandemic evaluations indicating that hybrid healthcare models can effectively maintain treatment outcomes while optimizing resource use (12,13). Moreover, digital health tools like home BP monitoring, electronic reminders, and virtual health coaching can further augment the impact of telemedicine (14,15).

 

However, the study is not without limitations. First, self-reported BP readings in the telemedicine group may introduce bias or inaccuracies compared to clinic-based measurements. Second, the study duration of six months, although sufficient to assess short-term outcomes, may not capture the long-term sustainability and cardiovascular benefits of either modality. Additionally, socioeconomic and digital literacy factors were not analyzed, which could influence both access and effectiveness of telehealth services.

 

Despite these limitations, the study contributes valuable insights to healthcare systems considering the integration of telemedicine in routine hypertension management. It underscores the feasibility and acceptability of remote care models and supports their continued use beyond the exigencies of the COVID-19 pandemic.

CONCLUSION

This study highlights that telemedicine is as effective as in-person consultations for managing hypertension in the post-COVID era, showing comparable outcomes in blood pressure control and medication adherence. Moreover, telehealth offers higher patient satisfaction due to its convenience and accessibility. These findings support the integration of telemedicine as a sustainable and patient-centered approach in chronic disease management.

REFERENCES
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  2. Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, et al. Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Cochrane Database Syst Rev. 2022;2:CD014217.
  3. Hatef E, Wilson RF, Hannum SM, Zhang A, Kharrazi H, Weiner JP, et al. Use of Telehealth During the COVID-19 Era [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2023. Report No.: 23-EHC005.
  4. Kodjebacheva GD, Culinski T, Kawser B, Coffer K. Satisfaction with telehealth services compared with nontelehealth services among pediatric patients and their caregivers: systematic review of the literature. JMIR Pediatr Parent. 2023;6:e41554.
  5. Totten AM, Hansen RN, Wagner J, Stillman L, Ivlev I, Davis-O’Reilly C, et al. Telehealth for Acute and Chronic Care Consultations [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019. Report No.: 19-EHC012-EF.
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  7. Livingston NA, Sarpong A, Sistad R, Roth C, Banducci AN, Simpson T, et al. Gender differences in receipt of telehealth versus in-person behavioral therapy, medication for opioid use disorder (MOUD), and 90-day MOUD retention during the pandemic: a retrospective veteran cohort study. J Subst Use Addict Treat. 2024;156:209188.
  8. Cantor AG, Jungbauer RM, Totten AM, Tilden EL, Holmes R, Ahmed A, et al. Telehealth strategies for the delivery of maternal health care: a rapid review. Ann Intern Med. 2022;175(9):1285–97.
  9. Totten A, Womack DM, McDonagh MS, Davis-O’Reilly C, Griffin JC, Blazina I, et al. Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022. Report No.: 22(23)-EHC023.
  10. Ripp A, Steinway C, Katzow MW, Jan S, Chen J, Chen V. Telehealth utilization and follow-up visits in developmental-behavioral pediatrics during the COVID-19 pandemic in 2020. J Dev Behav Pediatr. 2022;43(5):297–302.
  11. Chaudhry H, Nadeem S, Mundi R. How satisfied are patients and surgeons with telemedicine in orthopaedic care during the COVID-19 pandemic? A systematic review and meta-analysis. Clin Orthop Relat Res. 2021;479(1):47–56.
  12. Adhikari S, Titus AR, Baum A, Lopez P, Kanchi R, Orstad SL, et al. Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes. BMC Health Serv Res. 2023;23(1):41.
  13. Das AK, Chang E, Paydar C, Broder MS, Orroth KK, Cordey M. Apremilast adherence and persistence in patients with psoriasis and psoriatic arthritis in the telehealth setting versus the in-person setting during the COVID-19 pandemic. Dermatol Ther (Heidelb). 2023;13(9):1973–84.
  14. Cantor A, Nelson HD, Pappas M, Atchison C, Hatch B, Huguet N, et al. Effectiveness of Telehealth for Women’s Preventive Services [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022. Report No.: 22-EHC024.
  15. Kim BI, Peairs E, Lander S, Antonelli C, Lau BC. Telehealth physical therapy for sports medicine rehabilitation: what is its role in the postpandemic era? Orthop J Sports Med. 2022;10(10):23259671221127721.
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