Changes in Home Versus Clinic Blood Pressure With Antihypertensive Treatments

Abstract

Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare with the changes in clinic BP (CBP). We searched PubMed using the terms “home or self-measured blood pressure,” and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects. As there was significant heterogeneity in most of the outcomes, a random effects model was used for the meta-analyses. The mean changes (± standard error) in CBP and HBP (systolic/diastolic) were -15.2±0.03/-10.3±0.03 mmHg and -12.2±0.04/-8.0±0.04 mmHg respectively, although there were wide varieties of differences in the reduction between HBP and CBP. The reductions in CBP were correlated with those of HBP (systolic BP; r=0.66, B=0.48, diastolic BP; r=0.71, B=0.52, P<0.001). In 7 studies that also included 24-hour BP monitoring, the reduction of HBP was greater than that of 24-hr BP in systolic (HBP; -12.6±0.06 mmHg, 24-hr BP; -11.9±0.04 mmHg, P<0.001). In 5 studies that included daytime and nighttime systolic BP separately, HBP decreased 15% more than daytime ambulatory BP and 30% more than nighttime ambulatory BP. In conclusion, HBP falls about 20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP.

Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension

“…[28][29][30] This is in concordance with results from this study and might be caused, at least in part, by regression to the mean. 31 The fact that ABPM was not used to qualify patients for entry into the study means that some patients with ABPM levels in the nonhypertensive range were included (n=7; 15.9%).…”

Rumination in the laboratory: What happens when you go back to everyday life?

“…Moreover, the findings showed that rumination outside the laboratory was associated with large increases in ambulatory SBP and DBP, 19 mm Hg and a 11 mm Hg, respectively, after statistical adjustments for age and BMI. This result is particularly intriguing if we consider the prognostic value of BP for the development of cardiovascular disease (Boggia et al, 2007), and that a 10 mm Hg change is the target to evaluate the efficacy of antihypertensive medications (Ishikawa, Carroll, Kuruvilla, Schwartz, & Pickering, 2008). We also showed a relationship between BP reactivity to the anger interview in the laboratory and ambulatory BP increases from nonrumination to rumination periods in daily life.…”

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

“…43,44 Indeed, a recent meta-analysis describing the changes in BP in subjects treated with antihypertensive medication or placebo has demonstrated the improved stability The equivalence of SBPM with ABPM N McGowan and PL Padfield of self-measurements, rather than clinical measurements. 45 There is also evidence that the use of SBPM can lead to improved compliance with antihypertensive medication 46 and improved BP control. 47,48 Although ABPM has been shown to be costeffective 9,10 in diagnosing hypertension, it is impractical for assessing and managing all patients in primary care.…”