Guillaume Bobrie, M.D., from the Hopital Europeen Georges Pompidou, Paris, and colleagues from the SHEAF (Self-Measurement of Blood Pressure at Home in the Elderly: Assessment and Follow-up) study assessed the prognostic value of home versus office blood pressure measurement by general practitioners in a European population of elderly patients treated for hypertension (high blood pressure). Office and home blood pressure and cardiac risk factors were measured at baseline (the start of the study) in a group of 4,939 patients being treated for hypertension. The average age of the study participants was 70 years and 48.9 percent of the participants were men. The patients were followed up for an average of 3.2 years.
The researchers report that at the end of the study follow-up at least one cardiovascular event (for example: cardiovascular cause of death, or non-fatal heart attack, stroke, angioplasty, coronary artery bypass graft surgery) had occurred in 324 patients. "For BP (blood pressure) self-measurement at home, each 10-mm Hg (millimeters of mercury) increase in systolic [first, larger BP number] BP increased the risk of a cardiovascular event by 17.2 percent and each 5-mm Hg increase in diastolic [second, smaller BP number] BP increased that risk by 11.7 percent," the authors write. "Conversely, for the same increase in BP observed using office measurement, there was no significant increase in the risk of a cardiovascular event."
"In conclusion, home BP self-measurement has a better prognostic value than office BP measurement. In this elderly population, office BP measurement failed to identify 13 percent of patients with elevated BP in the office but not at home with a good prognosis and 9 percent of those with elevated BP at home but not in the office with a poor prognosis. The frequency of this double error, which is both diagnostic (with respect to the control of hypertension) and prognostic (with respect to the incidence of cardiovascular events), suggests that the monitoring of patients being treated for hypertension must include home BP self-measurement, which is the method preferred by patients, with an excellent feasibility."
(JAMA. 2004;291:1342-1349. Available post-embargo at JAMA.com)
Editor's Note: The study was supported by funding from Laboratoire Aventis.
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JAMA