Home blood pressure measurements associated with better blood pressure control: the J-HOME study

Abstract

The usefulness of self-measurements of blood pressure (BP) at home (home BP measurements) in hypertensive patients has been reported by many studies. Several national guidelines recommend the use of home BP measurements to achieve better hypertension control. The objective of this study was to clarify the association between home BP measurements and hypertension treatment among 2363 essential hypertensive patients taking antihypertensive drugs. Compared to the 543 (23.0%) patients who had not taken home BP measurements, the 1820 (77.0%) patients who had taken home BP measurements were significantly older, included a higher proportion of males, included a higher proportion with a family history of hypertension, took a greater number of antihypertensive drugs and alpha blockers and took antihypertensive drugs more often in the evening. Home BP measurements were associated with significantly better control of home and office BP levels. Compared to patients who had not taken home BP measurements, the adjusted odds ratios for good control of morning home BPs, evening home BPs and office BPs in patients who had taken home BP measurements were 1.46 (95% confidential interval (CI) 1.33-1.57), 1.35 (95% CI 1.21-1.47) and 1.23 (95% CI 1.06-1.37), respectively. Home BP measurements were associated with good hypertensive management. Our findings suggest that it is important that physicians recommend home BP measurements to their patients.

Home blood pressure measurement: a means for improving blood pressure control?

“…The first notable observation provided by this study is that the proportion of patients measuring HBP in a Japanese primary care setting is similar to, 15 or even higher 14 than, that reported by European specialist settings; this difference may result from a more careful management of hypertension in that country, as reflected by the high degree of clinic BP control (440%) reported in the present study. The second interesting finding of the study by Obara et al 12 , which confirms and extends previously published data, is that BP control was better among patients practising HBP either in the office or outside the office environment. This observation adds a new piece of information over previous reports investigating the role of HBP compared to office BP measurement in BP control.…”

“…In contrast to Japan Home versus Office BP Measurement Evaluation data, previous studies have shown that hypertension management based on HBP targets is associated with less intensive therapeutic regimens in the office as well as outside the office BP control. 19,21 Despite the documented value of HBP in improving medical management and patients' compliance, prospective studies are needed to confirm or refute the findings by Obara et al 12 and to establish whether and how HBP is an effective way for improving BP control in the hypertensive population. The interest in this field is evident by the increasing literature on this topic-even in this journal [22][23][24] -in relation to uptake and implications of home HBP measurements.…”

“…In their paper, Obara et al 12 evaluated the association between HBP and hypertension control by analysing data from the Japan Home versus Office BP Measurement Evaluation, a register including a randomly selected nationwide population of 2263 treated essential hypertensives (mean age 66 ± 10 years, 44% men). All patients prospectively underwent a clinical interview by a structured questionnaire, HBP and office BP measurements over a 2-week period.…”

“…[6][7][8][9] In addition, HBP has been shown to be free of the placebo effect, to improve patients' compliance and to be useful in detecting white-coat and masked hypertension phenomena. 10,11 As a consequence, HBP is now considered a useful procedure not only in complementing clinic BP readings for the management of hypertensive patients in daily practice but also in providing substantial information in clinical research.In this issue of the Journal of Human Hypertension Obara et al 12 describe the results of a study about the association between HBP measurement and hypertension control among a Japanese population of essential hypertensives in a primary care setting. Factors associated with patients' preference for HBP measurement were also addressed.…”

“…In this issue of the Journal of Human Hypertension Obara et al 12 describe the results of a study about the association between HBP measurement and hypertension control among a Japanese population of essential hypertensives in a primary care setting. Factors associated with patients' preference for HBP measurement were also addressed.…”