Jan A. Staessen, M.D., Ph.D., from University of Leuven, Leuven, Belgium, and colleagues from the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) Trial Investigators, compared self-measurement and conventional office measurement of blood pressure in the treatment of patients with hypertension (high blood pressure). The study included 400 patients with a diastolic blood pressure (the lower number in the blood pressure measurement, such as for a blood pressure of 140/80, the diastolic pressure is 80) reading of 95 mm Hg (millimeters of mercury) or more as measured at physicians' offices and then randomized them to receive antihypertensive drug treatment based on office blood pressure readings (n=197) or home blood pressure readings (n=203). The study took place between March 1997 to April 2002 in Belgium and Dublin, Ireland. The participants recorded several (usually 6) home measurements a day and averaged the daily BP over one week. The other group's measurements were averaged from three readings at the physicians' office. The patients were followed up for one year.
"At the end of the study, more home BP (blood pressure) than office BP patients had stopped antihypertensive drug treatment (25.6 percent vs. 11.3 percent) with no significant difference in the proportions of patients progressing to multiple-drug treatment (38.7 percent vs. 45.1 percent)," the researchers found. "The final office, home, and 24-hour ambulatory BP measurements were higher in the home BP group than in the office BP group."
"In conclusion, adjustment of antihypertensive treatment based on home BP instead of office BP led to less-intensive drug treatment and marginally lower costs but also to less BP control, with no differences in general well-being or left ventricular mass," the authors write. "Self-measurement helps to identify patients with white-coat hypertension [abnormal elevation of blood pressure only in the physician's office]. Our findings support a step-wise strategy for the evaluation of BP in which self-measurement and ambulatory monitoring are complementary to conventional office measurement."
(JAMA. 2004;291;955-964. Available post-embargo at JAMA.com)
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