TELEMONITORING OF HYPERTENSION AND DIABETES MELLITUS IN PRIMARY HEALTH CARE AND IMPLICATIONS FOR BRAZIL'S UNIFIED HEALTH SYSTEM: A NARRATIVE REVIEW

Abstract

Introduction: Systemic arterial hypertension (SAH) and type 2 diabetes mellitus (T2DM) account for a large part of the workload in Primary Health Care (PHC), and telemonitoring has been put forward as a way to expand the longitudinal follow-up of these patients in the Brazilian Unified Health System (SUS). Objective: To analyze the evidence on clinical effectiveness, cost-effectiveness, acceptability and implementation barriers of telemonitoring for SAH and DM in PHC and to discuss what it means for the SUS. Methods: Narrative review. Searches were carried out in September 2026 in PubMed/MEDLINE, the Virtual Health Library (BVS) and SciELO, using the descriptors telemonitoring, telemedicine, remote patient monitoring, hypertension, diabetes mellitus and primary health care, combined with the Boolean operators AND and OR. Studies in Portuguese, English and Spanish were selected, with priority given to clinical trials, meta-analyses and Brazilian studies. Results: In hypertension, telemonitoring lowered systolic blood pressure by 3.4 to 6.6 mmHg when it was accompanied by structured clinical support, with medication adjustment and team follow-up. When it was limited to data transmission, or when it was compared with well-organized in-person team care, there was no difference. In diabetes, findings were heterogeneous and most trials showed no effect on glycated hemoglobin. The main barriers were digital exclusion of older adults and rural residents, team overload and lack of integration with electronic health records; Brazilian studies added lack of equipment, staff turnover and irregular patient adherence. A pilot trial in the United States suggests that interventions designed for underrepresented populations can reduce inequalities in access. Conclusion: Telemonitoring of SAH and DM can be useful in PHC, provided it is linked to team-based clinical support. In the SUS, its incorporation depends on investment in infrastructure, team training, attention to digital equity and national studies on effectiveness and cost.