Home blood pressure measurements associated with better blood pressure control: the J-HOME study (original) (raw)
Related papers
American Journal of Hypertension, 2005
Background: The purpose of this study was to compare home and ambulatory blood pressure (BP) in the adjustment of antihypertensive treatment. Methods: After a 4-week washout period, patients whose untreated daytime diastolic ambulatory BP averaged Ն85 mm Hg were randomized to be treated according to their ambulatory or home BP. Antihypertensive treatment was adjusted at 6-week intervals according to the mean daytime ambulatory diastolic BP or the mean home diastolic BP, depending on the patient's randomization group. If the diastolic BP stayed above 80 mm Hg, the physician blinded to randomization intensified hypertensive treatment. Results: Ninety-eight patients completed the study. During the 24-week follow-up period both systolic and diastolic BP decreased significantly within both groups (P Ͻ .001). At the end of the study, the systolic/diastolic differences between ambulatory (n ϭ 46) and home (n ϭ 52) BP groups in home, daytime ambulatory, night-time ambulatory, and 24-h ambulatory BP changes averaged 2.6/2.6 mm Hg, 0.6/1.7 mm Hg, 1.0/1.4 mm Hg, and 0.6/1.5 mm Hg, respectively (P range .06 to .75) A nonsignificant trend to more intensive drug therapy in the ambulatory BP group and a nonsignificant trend to larger share of patients reaching (57.7% v 43.5%, P ϭ .16) the target pressure in the home BP group was observed due to the 3.8 mm Hg difference in ambulatory and home diastolic BP at randomization. Conclusions: The adjustment of antihypertensive treatment based on either ambulatory or home BP measurement led to good BP control. No significant betweengroup differences in BP changes were seen at the end of the study. Additional research is needed to provide more conclusive results.
Self-measured home blood pressure in predicting ambulatory hypertension
American journal of hypertension, 2004
Physicians are commonly uncertain whether a person with office blood pressure (BP) around 140/90 mm Hg actually has hypertension. This is primarily because of BP variability. One approach is to perform self-measured home BP and determine if home BP is elevated. There is a general agreement that if home BP is >/=135/85 mm Hg, then antihypertensive therapy may be commenced. However, some persons with home BP below this cut-off will have ambulatory hypertension. We therefore prospectively study the role of home BP in predicting ambulatory hypertension in persons with stage 1 and borderline hypertension. We studied in a cross-sectional way home and ambulatory BP in a group of 48 patients with at least two elevated office BP readings. The group was free of antihypertensive drug therapy for at least 4 weeks and performed 7 days of standardized self-BP measurements at home. We examined the relationships of the three BP methods and also defined a threshold (using receiver operating curve...
Usefulness of Home Blood Pressure in the Diagnosis and Control of Hypertension in Primary Care
Current Hypertension Reviews, 2006
Self-measurement of blood pressure (BP) at home has gained increasing importance for the diagnostic and therapeutic evaluation of hypertensive patients. In comparison with clinic BP, self-measurement of BP with automated devices has several advantages: (1) higher reproducibility; (2) elimination of the "white coat effect" and observer bias; and (3) improvement of both compliance and BP control. Furthermore, there is evidence that home BP better correlates with target-organ damage and prognosis and provides a more accurate evaluation of treatment effect. On the other hand, it has great potential advantages of lower equipment and staff cost compared with ambulatory BP. These features of home BP have led various medical organizations to recognize its clinical usefulness in the diagnosis of white coat hypertension and in evaluating response to antihypertensive medication, particularly in the primary care setting. We aim here to present a critical review of the uses, strengths and weaknesses of the technique of home BP monitoring for the assessment of hypertension in the clinical practice.
Hypertension, 2007
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. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; PϽ0.001) with lower costs ($3222 versus $4420 per 100 patients per month; PϽ0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; Pϭ0.25/0.20), in changes in left ventricular mass index (Ϫ6.5 g/m 2 versus Ϫ5.6 g/m 2 ; Pϭ0.72), or in median urinary microalbumin concentration (Ϫ1.7 versus Ϫ1.5 mg per 24 hours; Pϭ0.87). 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 (PϽ0.05) for systolic and 77.2 versus 76.1 mm Hg (PϽ0.05) 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. (Hypertension. 2007;50:1019-1025.) 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.
Home Blood Pressure Measurement - Epidemiology and Clinical Application
2008
Hypertension, the leading global risk factor for early mortality, can not be detected or treated without accurate and practical methods of BP measurement. Although home blood pressure (BP) measurement enjoys considerable popularity among patients, the lack of evidence needed to assure its place in modern clinical practice has hindered its widespread acceptance among physicians. The objective of this study was to show that home BP measurement is more accurate than conventional clinic BP measurement and can be used effectively in clinical practice. We assessed the use of home BP for diagnosing hypertension and guiding antihypertensive treatment. The association between home BP and hypertensive end-organ damage was also examined. The first study population consisted of a representative sample of the Finnish adult population (2 120 individuals aged 45-74 years). These subjects underwent a clinical interview, electrocardiography and measurement of clinic and home BP. Carotid intima-media thickness (an indicator of atherosclerosis) and arterial pulse wave velocity (an indicator of arterial stiffness) were also measured in two subsets of 758 and 237 subjects, respectively. In a second study cohort, consisting of 98 hypertensive patients, adjustment of antihypertensive treatment was randomized to either daytime ambulatory BP or home diastolic BP. Clinic BP was significantly higher than home BP (mean systolic/diastolic difference was 8/3 mmHg), and the overall agreement between the two methods in diagnosing hypertension was moderate at best (75%). Of 593 subjects with elevated clinic BP, 38% had normal BP at home; so called white-coat hypertension. Hypertension could therefore be overdiagnosed in every third patient in a clinical screening situation. White-coat hypertension was associated with mildly elevated clinic BP, lower body mass index and non-smoking status, but not with psychiatric disease. However, the cardiovascular risk profile of white-coat hypertensives was between that of the normotensives and sustained hypertensives, indicating that white-coat hypertension is not a completely benign phenomenon, and may be a precursor of true hypertension. Home BP was more closely associated with hypertensive end-organ damage (intima-media thickness, pulse wave velocity, and electrocardiographic evidence of left ventricular hypertrophy) than was clinic BP. The adjustment of antihypertensive treatment based on home BP measurement is effective as it led to equally good BP control as did ambulatory BP monitoring, which has been considered by many as the gold standard. On the basis of these results and data from previous studies, it can be concluded that home BP measurement is an improvement over conventional clinic BP measurement. Home monitoring of BP is as a convenient, accurate, and widely available option and may become the method of choice when diagnosing and treating hypertension. A paradigm shift is needed in BP measurement as evidencebased medicine suggests that clinic BP measurement should only be used for screening purposes.
Jananese Society of Hypertension (JSH) Guidelines for Self-Monitoring of Blood Pressure at Home
Hypertension Research, 2003
on Behalf of the Japanese Society of Hypertension Home blood pressure (BP) measurements are indispensable for the improvement of hypertension management in medical practice as well as for the recognition of hypertension in the population. The Working Group for Establishment of Guidelines for Measurement Procedures of Self-Monitoring of Blood Pressure at Home of the Japanese Society of Hypertension has established standards for all techniques and procedures of home BP measurements. The recommendations are as follows. Recommendation: 1) Arm-cuff devices based on the cuff-oscillometric method that have been validated officially, and the accuracy of which has been confirmed in each individual, should be used for home BP measurement. 2) The BP should be measured at the upper arm. Finger-cuff devices and wrist-cuff devices should not be used for home BP measurements. 3) Devices for home BP measurement should be adapted to the American Association for Medical Instrumentation (AAMI) standards and the British Hypertension Society (BHS) guidelines. In addition, the difference between the BP measured by the auscultatory method and that measured using the device should be within 5 mmHg in each individual. The home measurement device should be validated before use, and at regular intervals during use. 4) Home BP should be monitored under the following conditions. The morning measurement should be made within 1 h after waking, after micturition, sitting after 1 to 2 min of rest, before drug ingestion, and before breakfast. The evening measurement should be made just before going to bed, sitting after 1 to 2 min of rest. 5) Home BP should be measured at least once in the morning and once in the evening. 6) All home BP measurements should be documented without selection, together with the date, time, and pulse rate. Use of devices with a printer or an integrated circuit memory is useful to avoid selection bias. 7) The home BP in the morning and that in the evening should be averaged separately for a certain period. The first measurement on each occasion should be used for totaling. 8) Home BP values averaged for a certain period indicate hypertension when 135/80 mmHg and over and definite hypertension when 135/85 mmHg and over. Normotension is defined as less than 125/80 mmHg and definite normotension as less than 125/75 mmHg. Home BP measurements based on these guidelines can be considered an appropriate tool for clinical decision-making, and it is hoped that these guidelines will serve to reduce confusion and confirm the place of home BP measurement in clinical practice. (Hypertens Res 2003; 26: 771-782)
Home Blood Pressure Measurement
Journal of The American College of Cardiology, 2005
The purpose of this research was to review the literature on home blood pressure measurement (HBPM) and to provide recommendations regarding HBPM assessment. Observational studies on HBPM, published after 1992, as identified by PubMed, EMBASE, and Cochrane literature searches were reviewed. Studies were selected if they met the following criteria: 1) self-measurements had been performed with validated devices; 2) measurement procedures were described in sufficient detail; and 3) papers clearly explained how final HBPM results were calculated upon which conclusions and/or treatment decisions were based. Office blood pressure measurement (OBPM) yields higher blood pressure values than HBPM. For systolic blood pressure, differences between OBPM and HBPM increase with age and the height of office pressure. Differences also tend to be greater in men than in women and greater in patients without than in those with antihypertensive treatment. Furthermore, HBPM can diagnose normotension with almost absolute certainty; it correlates better with target organ damage and cardiovascular mortality than OBPM, it enables prediction of sustained hypertension in patients with borderline hypertension, and it proves to be an appropriate tool for assessing drug efficacy. Despite some limitations and although more data are needed, HBPM is suitable for routine clinical practice. (J Am Coll Cardiol 2005;46:743-51)
Home Readings of Blood Pressure in Assessment of Hypertensive Subjects
Acta Medica Scandinavica, 2009
Outpatient clinic blood pressure (OPC-BP) was compared to home blood pressure (Home-BP) measured three times daily during a two week period in 122 consecutively referred hypertensive subjects. A semi-automatic device (TM-101) including a microphone for detection of Korotkoff-sounds, selfdeflation of cuff pressure and digital display of blood pressure was used. Mean difference between OPC-BP and Home-BP was systolic + 13 mm Hg (range-21-+ loo mg Hg) and diastolic + 5 mm Hg (Irange-2 7-+ 36 mm Hg). Although a significant correlation could be demonstrated between Home-BP and OPC-BP, the inter-individual scatter was pronounced and unpredictable from the hypertensive organ damages. It is argued, that home readings should be used to greater extent in the evaluation of patients with hypertension.