Self-Measurement of Blood Pressure at Home Reduces the Need for Antihypertensive Drugs: A Randomized, Controlled Trial

Department of General Practice, University of Groningen, Groningen, Groningen, Netherlands
Hypertension (Impact Factor: 6.48). 12/2007; 50(6):1019-25. DOI: 10.1161/HYPERTENSIONAHA.107.094193
Source: PubMed


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 (n=216) or office pressures (OPs; n=214). 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. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (-6.5 g/m(2) versus -5.6 g/m(2); P=0.72), or in median urinary microalbumin concentration (-1.7 versus -1.5 mg per 24 hours; P=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.

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    • "Adjustment of antihypertensive treatment based on home blood pressure led to less intensive drug treatment and marginally lower costs, but also to less blood pressure control, with no differences in quality of life and target organ damage. Similarly, in the HOMERUS (Home versus Office blood pressure MEasurements: Reduction of Unnecessary treatment Study) trial [43] self-measurement of blood pressure at home led to less medication use than office blood pressure measurement without leading to significant differences in office blood pressure values or target organ damage. However, in both the aforementioned studies, the target value for home blood pressure was the same as that for office blood pressure and higher than that recommended by current guidelines [9,39]. "
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    ABSTRACT: Background Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient’s therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. Methods/design The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension - both in the office and in ambulatory conditions over 24 h - and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n=84) or HBPT (n=168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (<135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome). Discussion The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. Trial registration Clinical NCT01541566
    Full-text · Article · Jan 2013 · Trials
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    • "The treatment programs for hypertension and hypercholesterolemia were the same for both groups, except for the use of home monitoring in blood pressure management for the intervention group. However, decreased use of medication in the intervention group might have been expected, because of reduced white coat effect and more feedback and subsequent adherence to therapy [12]. One possible explanation is that the target blood pressure values were 135/85 mmHg for home measured values in this study, compared to 140/90 mmHg for office measured values. "
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    ABSTRACT: Treatment goals for cardiovascular risk management are generally not achieved. Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid. The aim of this study was to compare standard treatment supported by self-monitoring with standard treatment without self-monitoring, both conducted by practice nurses, on cardiovascular risk and separate risk factors. Men aged 50–75 years and women aged 55–75 years without a history of cardiovascular disease or diabetes, but with a SCORE 10-year risk of cardiovascular mortality ≥5% and at least one treatable risk factor (smoking, hypertension, lack of physical activity or overweight), were randomized into two groups. The control group received standard treatment according to guidelines, the intervention group additionally received pro-active counseling and self-monitoring (pedometer, weighing scale and/ or blood pressure device). After one year treatment effect on 179 participants was analyzed. SCORE risk assessment decreased 1.6% (95% CI 1.0–2.2) for the control group and 1.8% (1.2–2.4) for the intervention group, difference between groups was .2% (−.6–1.1). Most risk factors tended to improve in both groups. The number of visits was higher and visits took more time in the intervention group (4.9 (SD2.2) vs. 2.6 (SD1.5) visits p < .001 and 27 (P25 –P75:20–33) vs. 23 (P25 –P75:19–30) minutes/visit p = .048). In both groups cardiovascular risk decreased significantly after one year of treatment by practice nurses. No additional effect of basing the pro-active counseling on self-monitoring was found, despite the extra time investment. Trial registration NTR2188
    Full-text · Article · Sep 2012 · BMC Family Practice
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    ABSTRACT: The consequences of systemic hypertension still affect large segments of the world's population, including Brazil, despite many well-known and efficacious nondrug and drug therapies. It is critical for patients to understand these interventions and comply with them, in order to improve hypertension control rates among populations. Home blood pressure monitoring may help in this context, and many randomized clinical trials have been conducted to test its efficacy. Their findings have been somewhat inconsistent, and when treatment is modified on the basis of home readings, blood pressure control both at Ambulatory Blood Pressure Monitoring and at physicians' office may be reduced. As yet, no studies have been conducted to assess the isolated efficacy of home blood pressure monitoring through automatic devices to improve adherence, with no modifications to treatment prescribed on the basis of office blood pressure.
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