Home BP monitoring ‘could help guide dosing, titration’

By Caroline Price

Researchers report that home blood pressure monitoring provides a reliable indicator of blood pressure control in elderly patients.

Provided it is done properly, the approach could help guide drug dosing and titration in these patients, say William Cushman (University of Tennessee, Memphis, USA) and colleagues, writing in the Journal of the American Society of Hypertension.

The team calls for greater use of home blood pressure monitoring in clinical practice, especially in the older hypertensive population. Older patients can find it difficult to attend clinics regularly, and are more prone to white-coat hypertension and variability in blood pressure than younger patients, the researchers note. Moreover, older patients are more likely to record home measurements.

Cushman et al draw their conclusions come from analysis of data from a 16-week randomized trial in 384 patients, aged 70 years or older, of different antihypertensive regimens, namely an angiotensin receptor blocker (ARB) and a thiazide diuretic combined, the ARB as monotherapy, and the thiazide diuretic as monotherapy.

Participants underwent clinic blood pressure measurement at 2, 4, 8, 12, and 16 weeks. In addition, they were each given a home blood pressure measurement device for weekly monitoring; in this analysis, the researchers focused on the measurements taken at home during the morning of the scheduled office visit, before coming into the clinic.

Baseline clinic blood pressure readings were around 3/1 mmHg higher than baseline home readings (165.5 vs 162.5 mmHg). Within each treatment group there were no significant differences between clinic and baseline readings.

Overall reductions in blood pressure at 4 weeks were similar by clinic and home measurement (12.6 and 10.9 mmHg), and within each treatment group the pattern of home blood pressure reduction over time was similar to the clinic measurement findings.

Furthermore, there was no difference in the proportion of patients overall and within each treatment group that achieved a blood pressure below 140/90 mmHg, or below 135/85 mmHg, either at week 4 or at week 16.

Estimated Spearman correlation coefficients showed a significant correlation between clinic and home measures of blood pressure, both for baseline measurements and the changes from baseline. And, finally, based on the measurement standard deviations, there was similar variability in both clinic and home readings from 4 weeks onwards.

"Home blood pressure monitoring has several advantages over clinic blood pressure monitoring," comment the authors. "Home blood pressure monitoring allows the health care professional to capture daily and weekly blood pressure measurements from patients without such frequent visits to the clinic, with the potential to curtail the escalating costs of health care and help guide treatment decisions."

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