title: Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial.
abstract: 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 (n=216) or office pressures (OPs; n=214). 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; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (-6.5 g/m(2) versus -5.6 g/m(2); P=0.72), or in median urinary microalbumin concentration (-1.7 versus -1.5 mg per 24 hours; P=0.87). 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 (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) 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.
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands. willem.verberk@intmed.unimaas.nl
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Verberk
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.forename: Jacques W M
authors.initials: JW
authors.lastname: Lenders
authors.forename: Alfons G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: Gert A
authors.initials: GA
authors.lastname: van Montfrans
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Smit
authors.forename: Paul-Hugo M
authors.initials: PH
authors.lastname: van der Kuy
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Nelemans
authors.forename: Roger J M W
authors.initials: RJ
authors.lastname: Rennenberg
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Frank W
authors.initials: FW
authors.lastname: Beltman
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.forename: Daniëlle E M
authors.initials: DE
authors.lastname: Brunenberg
authors.forename: Carmen
authors.initials: C
authors.lastname: Dirksen
authors.forename: Theo
authors.initials: T
authors.lastname: Thien
authors.forename: Peter W
authors.initials: PW
authors.lastname: de Leeuw
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D004311:Double-Blind Method; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011446:Prospective Studies; D012648:Self Care
chemical_list: D000959:Antihypertensive Agents