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Cited by 288Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionClinical practice guidelines implementation

Antihypertensive Treatment Based on Blood Pressure Measurement at Home or in the Physician's Office<SUBTITLE>A Randomized Controlled Trial</SUBTITLE>

Staessen, Jan A.·2004·JAMA
DOI 10.1001/jama.291.8.955
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Abstract

CONTEXT: Self-measurement of blood pressure is increasingly used in clinical practice, but how it affects the treatment of hypertension requires further study. OBJECTIVE: To compare use of blood pressure (BP) measurements taken in physicians' offices and at home in the treatment of patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS: Blinded randomized controlled trial conducted from March 1997 to April 2002 at 56 primary care practices and 3 hospital-based outpatient clinics in Belgium and 1 specialized hypertension clinic in Dublin, Ireland. Four hundred participants with a diastolic BP (DBP) of 95 mm Hg or more as measured at physicians' offices were enrolled and followed up for 1 year. INTERVENTIONS: Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the self-measured DBP at home (average of 6 measurements per day during 1 week; n = 203) or the average of 3 sitting DBP readings at the physician's office (n = 197). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below (<80 mm Hg) target, a physician blinded to randomization intensified antihypertensive treatment, left it unchanged, or reduced it, respectively. MEAN OUTCOME MEASURES: Office and home BP levels, 24-hour ambulatory BP, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and costs of treatment. RESULTS: At the end of the study (median follow-up, 350 days; interquartile range, 326-409 days), more home BP than office BP patients had stopped antihypertensive drug treatment (25.6% vs 11.3%; P<.001) with no significant difference in the proportions of patients progressing to multiple-drug treatment (38.7% vs 45.1%; P =.14). The final office, home, and 24-hour ambulatory BP measurements were higher (P<.001) in the home BP group than in the office BP group. The mean baseline-adjusted systolic/diastolic differences between the home and office BP groups averaged 6.8/3.5 mm Hg, 4.9/2.9 mm Hg, and 4.9/2.9 mm Hg, respectively. Left ventricular mass and reported symptoms were similar in the 2 groups. Costs per 100 patients followed up for 1 month were only slightly lower in the home BP group (3875 vs 3522 [4921 dollars vs 4473 dollars]; P =.04). CONCLUSIONS: Adjustment of antihypertensive treatment based on home BP instead of office BP led to less intensive drug treatment and marginally lower costs but also to less BP control, with no differences in general well-being or left ventricular mass. Self-measurement allowed identification of patients with white-coat hypertension. Our findings support a stepwise strategy for the evaluation of BP in which self-measurement and ambulatory monitoring are complementary to conventional office measurement and highlight the need for prospective outcome studies to establish the normal range of home-measured BP.

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Authors
Staessen, J. A.
Affiliations
KU Leuven (BE)
Corresponding author
Staessen, Jan A.
ORCID
Staessen, Jan A.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2004-02-25
Volume
291
Issue
8
Pages
955
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.291.8.955
OpenAlex
W2096784990
Cited by
288
References
34
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 2 · 2020: 8 · 2019: 14 · 2018: 12 · 2017: 11 · 2016: 13 · 2015: 18 · 2014: 13 · 2013: 21 · 2012: 23
FWCI
13.31
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
hypertension, antihypertensive therapy, home blood pressure monitoring, self-measured blood pressure, office blood pressure measurement, treatment intensification, ambulatory blood pressure, left ventricular mass, antihypertensive drug costs, treatment discontinuation, primary care, hypertension clinic, ambulatory blood pressure monitoring
MeSH terms
Antihypertensive Agents, Echocardiography, Electrocardiography, Fees, Medical, Female, Humans, Hypertension, Male, Middle Aged, Office Visits, Self Care, Single-Blind Method, Cost Savings, Blood Pressure Monitoring, Ambulatory

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