Self-Measurement of Blood Pressure at Home Reduces the Need for Antihypertensive Drugs

Abstract

Abstract-It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (nϭ216) or office pressures (OPs; nϭ214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. Key Words: blood pressure Ⅲ hypertension Ⅲ self-measurements Ⅲ home monitoring Ⅲ ambulatory blood pressure measurement Ⅲ treatment A s indications for lowering blood pressure (BP) become increasingly stringent, the associated medication use and costs rise markedly. 1 This calls for proper diagnosis and careful selection of patients in whom treatment is really indicated. In this respect, conventional office BP measurements (OBPMs) have disadvantages, because they can easily elicit a white-coat effect, overestimation of a patient's BP, 2 and unnecessary drug prescription. Self-BP measurements (SBPMs) are less liable to the white-coat effect 3 and may provide a more reliable estimate of a patient's "true" BP. In addition, SBPM correlates better with the development of target organ damage (TOD) than OBPM 4 -6 and for the occurrence of cardiovascular complications. 7,8 Therefore, SBPM has the potential to identify subjects that may not need treatment. This could reduce drug use and lead to considerable costs savings. The Home versus Office Measurement, Reduction of Unnecessary treatment Study (HOMERUS) was designed to determine whether treatment based on SBPM leads to a decreased drug prescription without an impaired BP control and TOD as compared with treatment based on OBPM. MethodsThe design of the HOMERUS has been described in detail elsewhere. 9 Briefly, HOMERUS is a multicenter, prospective, randomContinuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

“…However, although the use of home blood pressure may also reduce the intensity of drug treatment, it is unclear whether 24-h blood pressure control rates can be maintained. 23 Again using a high home blood pressure treatment target of 140 mm Hg for systolic and 90 mm Hg for diastolic blood pressure, Verberk et al 24 recently confirmed in a study of 430 participants with office hypertension that home blood pressure guided treatment may lead to less medication use, but this study also found significantly elevated 24-h blood pressure levels in the home blood pressure group. On the other hand, a small study among 98 participants with daytime ambulatory blood pressure of at least 85 mm Hg found similar blood pressure control rates whether antihypertensive therapy was adjusted based on home or 24-h blood pressure measurement.…”

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

“…4 Moreover, self-measurement of blood pressure increases adherence to antihypertensive treatment and allows reducing the number of clinic visits required for the diagnosis and treatment of hypertension. 6,7 The THOP (Treatment of Hypertension Based on Home or Office Blood Pressure) 8 and the HOMERUS (Home Versus Office Measurement -Reduction of Unnecessary Treatment) 9 trials demonstrated that adjustment of antihypertensive treatment based on HBP led to less intensive drug treatment with no differences in general well-being or target organ damage. However, no previous trial has assessed the long-term cardiovascular outcomes of antihypertensive therapy guided by self-measured HBP.…”

Are there really differences between home and daytime ambulatory blood pressure? Comparison using a novel dual-mode ambulatory and home monitor

“…The first 15 participants who fulfilled the protocol criteria regarding sex and entry BP were included in the analysis of phase 1 (8 The use of the tested device was straightforward with no operational problems during the study. There was one failure of the device to record BP throughout the study, which was successful on repeated measurement.…”

“…Some studies found no difference between HBP and daytime ABP, [4][5][6][7] whereas others showed the HBP values to be higher 8 or lower, 9-11 particularly in children and adolescents. [12][13][14] Differences in BP levels between the two methods in these studies are attributed to intrinsic differences between the two methods, but also, at least in part, to the different devices used for each method (ambulatory and home monitoring).…”

“…[1][2][3] Numerous studies have compared HBP with ABP measurements. [4][5][6][7][8][9][10][11][12][13][14] In each of these studies, HBP and ABP measurements have been obtained using different devices, usually oscillometric, but of different manufacturers specifically designed for each method. 15 Thus, the observed differences in BP levels between these two methods are attributed, at least in part, to the different devices used.…”