Home blood pressure measurement: a systematic review

OBJECTIVE: To determine how many self-measurements of blood pressure (BP) should be taken at home in order to obtain a reliable estimate of a patient's BP. DESIGN: Participants performed self blood pressure measurement (SBPM) for 7 days (triplicate morning and evening readings). In all of them, office blood pressure (three consecutive readings) and 24-h ambulatory blood pressure were obtained as well. Average SBPM values, obtained from several combinations of readings, were correlated with the results of ambulatory blood pressure measurement (ABPM). In addition, we assessed whether certain patient characteristics would influence such correlations. SETTING: Patients were recruited at hospital or general practice. PATIENTS: A total of 216 untreated hypertensive patients. RESULTS: The average SBPM value calculated from day 3 to day 7, omitting the first measurement of each morning and evening session, gave the best correlation with 24-h ABPM (r = 0.70). However, similar results were obtained from a SBPM value averaged from day 3 until 5 without the first measurement of each triplicate session. Overall, younger patients had significantly better correlations than older ones. Women had significantly better correlations with ABPM than men for systolic morning and daytime SBPM, whereas men had significantly better correlations for daytime and evening diastolic SBPM (P < 0.001). In addition, all correlations increased with lower systolic office blood pressure measurement (OBPM) values. CONCLUSIONS: A minimum number of 5 days of measurement is recommended to obtain a reliable estimate of a patient's usual BP. On each day, three consecutive morning and evening measurements should be performed. For calculating the average SBPM, the first 2 days and the first measurement of each triplicate measurements should be discarded. Moreover, patient characteristics may have an impact on the number of necessary self-measurements. However, because adhering to these recommendations will make SBPM a time-consuming procedure, this type of measurement should be performed only when a decision about starting or changing antihypertensive therapy is needed or in the case of special patient groups.

The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings.

(2003). Editorial: Recent hypertension guidelines: JNC-7 and 2003 ESH/ESC. Blood Pressure: Vol. 12, No. 4, pp. 196-197.

Recent hypertension guidelines: JNC-7 and 2003 ESH/ESC.

Management of hypertension in elderly diabetic patients.

http://www.scielo.br/pdf/clin/v63n1/v63n1a09.pdf

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

Objectives. To evaluate the use of ambulatory blood pressure monitoring in comparison with home and office blood pressure in every-day general practice. Methods. In a multicenter survey sixty-two practitioners previously unfamiliar with ambulatory blood pressure monitoring performed a total of 1162 (mean 18 ± 16; range 3-94) 24-h ambulatory- and home blood pressure measurements in normotensive subjects or patients with untreated or treated hypertension. Results. In subjects with office blood pressure <140/90 mmHg average 24-h ambulatory blood pressure (Tenso 24[Formula: See Text] monitors) was 126/79 mmHg, home blood pressure (Tenso Plus[Formula: See Text] semiautomatic sphygmomanometers) was 128/84 mmHg, and office blood pressure (standard sphygmomanometer) was 130/82 mmHg. Patients with office blood pressure ≥140/90 mmHg had 24-h ambulatory blood pressure averaging 141/88 mmHg, home blood pressure 149/93 mmHg, and office blood pressure 157/95 mmHg. The difference between office-, home-, and ambulator...

The Norwegian office-, home-, and ambulatory blood pressure study (NOHA)

BACKGROUND: The LIFE study (Losartan Intervention For Endpoint reduction in hypertension) is a randomized, double-blind comparison of losartan and atenolol-based treatment. The study hypothesis was that losartan would reduce cardiovascular morbidity and mortality more than traditional antihypertensive treatment with atenolol. MATERIAL AND METHODS: The study included 9193 patients in seven countries. RESULTS: By the end of the study, the mean dose was losartan 82 mg and atenonol 79 mg, whereas 94% of patients in both groups received additional hydrochlorothiazide. Blood pressure was reduced 30/17 mmHg by losartan and 29/17 mm Hg by atenolol. Despite the same reduction in blood pressure, the primary combined endpoint (cardiovascular mortality, non-fatal stroke and myocardial infarction) was reduced by 13.0% (p = 0.021) in the losartan group. Non-fatal and fatal strokes were reduced by 24.9% (p = 0.001). In two pre-specified subgroup analyses, cardiovascular mortality was reduced by 46% (p = 0.01) in patients with isolated systolic hypertension (n = 1326), and total mortality was reduced by 39% (p = 0.002) in patients with diabetes (n = 1159). INTERPRETATION: Losartan prevented more cardiovascular complications than atenolol for the same reduction in blood pressure and have positive additional effects beyond blood pressure control in patients with hypertension and left ventricular hypertrophy.

Gerhard Gerhardsen

Papers

The Norwegian office-, home-, and ambulatory blood pressure study (NOHA)

Treatment of hypertension in patients with left ventricular hypertrophy