A cardiovascular risk clinic using home BP monitoring.
BACKGROUND
Hypertension is the most common chronic condition managed in general practice, but blood pressure (BP) control is often suboptimal. Home blood pressure (HBP) monitoring can be more accurate than office based BP (OBP) monitoring, with HBP readings approximately 10/5 mmHg lower than OBP in the same patients.


METHODS
Hypertensive patients from a single general practice were invited to a cardiovascular risk review clinic using HBP monitoring. Outcome measures were BP reading, BP meeting adjusted target of 120/80 if aged <65 years or 130/85 if aged >65 years, owning home BP monitor, numbers enrolling and numbers attending 12 month follow up.


RESULTS
Of 524 eligible patients, 414 (79%) enrolled in the clinic, of whom 89% completed the trial. At 12 months, HBP control rates rose from 29.9% to 44.8%, with mean HBP falling 5.2/3.2 mmHg (p<0.001). Home BP monitor ownership rose from 54.3 to 82.9%.


CONCLUSIONS
This is the first study in standard Australian general practice using both a comprehensive clinic approach and HBP readings exclusively. This study provided a feasible management protocol and practical clinical performance indicators that could be used for a randomised controlled trial. Significantly better control rates were achieved compared with published studies for BP control.
Byrnes
Patrick D
PD
Rural Clinical School, University of Queensland, and a general practitioner, Bundaberg, Queensland. patrick@apmc.net.au
Mitchell
Geoffrey K
GK
Crawford
Margaret V
MV
McGoldrick
Colleen
C
D000368:Aged; D001315:Australia; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010067:Ownership / Q000706:statistics & numerical data; D010865:Pilot Projects; D018570:Risk Assessment; D012307:Risk Factors