A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment

Home measurement and ambulatory 24-hour monitoring of blood pressure (BP) have many advantages over conventional office BP measurement and are increasingly used in clinical practice. However, their effect on the treatment of hypertension requires additional study. We assessed the hypothesis that the adjustment of antihypertensive treatment based on home BP instead of ambulatory BP would lead to equivalent BP control. After a 4-week wash-out period with placebo, a total of 110 patients whose daytime diastolic ambulatory BP averaged 85 mmHg or higher were randomized to either ambulatory BP or home BP groups. Antihypertensive treatment was then adjusted in a stepwise fashion at 6-week intervals according to the mean daytime ambulatory diastolic BP or the mean home diastolic BP during the preceding week, depending on the patient's randomization group. Both ambulatory BP monitoring and home BP measurement were performed on all patients during the study. If the diastolic BP guiding treatment was above 80 mmHg, a physician blinded to the randomization intensified hypertensive treatment; if equal to or below 80 mmHg the treatment was left unchanged. A total of 98 patients completed the study; 52 in the home BP group (age 54±1.4 y, 37% men) and 46 in the ambulatory BP group (age 54±1.0 y, 50% men). After a 24-week follow-up period BP was significantly reduced within both groups (p<0.01). The between-group differences in systolic and diastolic BP changes were statistically nonsignificant (p>0.05). An equal share of patients had progressed to multiple-drug treatment in the home and ambulatory BP groups (65.4% vs. 67.4%, p=0.83). We conclude that the adjustment of antihypertensive treatment based on home BP measurement instead of 24-hour ambulatory BP monitoring led to equally intensive drug treatment with preservation of BP control. (See Table) Changes in BPs After a 24-week Follow-up Values expressed as mean ± SEM. SBP, systolic blood pressure; DBP, diastolic blood pressure. Changes in BPs After a 24-week Follow-up Values expressed as mean ± SEM. SBP, systolic blood pressure; DBP, diastolic blood pressure.