ARTICLE IN PRESS

Evidence-Based Healthcare & Public Health (2004) 8, 253–254

KEYWORDHypertensiAmbulatorpressure mOffice visitAntihypertagents;Randomisecontrolled

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Summary

Question What is the effect of monitoring blood pressure at home on subsequenttreatment, compared to office-based blood pressure monitoring?

Study Design Randomised controlled trial.

Main results Drug treatment: after 1 year, more people measuring blood pressureat home reached target blood pressure and stopped antihypertensive treatmentcompared with those undergoing office measurement (26% vs. 11%; po0:001). Therewas no significant difference between groups in the proportion of people progressingto multiple drug treatment (home vs. office: 39% vs. 45%; p ¼ 014). Blood pressureand other symptoms: final blood pressure measurements were higher in the homeblood pressure group compared with the office group (mean difference at finalfollow up, home vs. office: systolic/diastolic 4.9/2.9mmHg vs. 6.8/3.5mmHg,po0:001). There were no significant differences in left ventricular mass andreported symptoms between groups. Cost: home measurement was slightly lessexpensive than office measurement (3875 euros vs. 3522 euros per 100 people permonth; p ¼ 0:04).

Authors’ conclusions Although home blood pressure readings lead to less intensivedrug treatment and lower costs, blood pressure was not as well controlled. Itidentifies people with white-coat hypertension and should be complementary toconventional office measurements.& 2004 Elsevier Ltd. All rights reserved.

Study Parameters

Question

What is the effect of monitoring blood pressure at home on subsequent treatment, compared to office-based blood pressure monitoring?

Study design

Randomised controlled trial.

Elsevier Ltd. All rights reserved.

n Hond E, Celis H et al. Antihypertensive treatment based on blood pressure measurement atndomized controlled trial. JAMA 2004; 291: 955–964.

ARTICLE IN PRESS

EVIDENCE-BASED HEALTHCARE MANAGEMENT254

Setting

56 primary care practices and 3 outpatients clinics in Belgium, plus one hypertension clinic in Dublin,Ireland; March 1997 to April 2002.

Participants

400 people with hypertension (average diastolic blood pressure: 95 to 114mm Hg over 3 consecutivereadings) without complications and a minimum age of 18 years. People with heart failure, unstable angina,myocardial infarction or stroke in previous year, severe non cardiovascular disease, mental disorders orsubstance abuse were excluded.

Intervention

Target diastolic blood pressure was between 80–89mm Hg. All participants received lisinopril (10mg/day)initially. Depending on readings provided at 2 monthly follow up visits, treatment was either reduced, orintensified by increasing the dose of lisinopril or combining lisinopril with other drugs (hydrochlorothiazide,amlodipine or prazosin). Treatment decisions were made by a doctor blinded to the treatment groups.

Main outcomes

Blood pressure (averaged over the seven days preceding each follow-up for self-measurements and overthree consecutive readings for office measurements). Intensity of drug treatment was measured in a step-wise fashion. Left ventricular mass was determined from electrocardiograms and echocardiographs.Symptoms were expressed on a five-point scale by questionnaire, and cost was based on the Belgium healthinsurance system.

Notes

There was complete follow-up of 347/400 participants (87%) at 12 months.

Sources of funding: AstraZeneca NV.

Abstract provided by Bazian Ltd, London