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- Title
Antihypertensive Treatment Based on Blood Pressure Measurement at Home or in the Physician's Office: A Randomized Controlled Trial.
- Authors
Staessen, Jan A.; Den Hond, Elly; Celis, Hilde; Fagard, Robert; Keary, Louis; Vandenhoven, Guy; O'Brien, Eoin T.
- 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 ...
- Subjects
BLOOD pressure measurement; HYPERTENSION; DRUG therapy; MEDICAL imaging systems; FEAR of doctors; CLINICAL trials; CLINICAL medicine; HEALTH outcome assessment
- Publication
JAMA: Journal of the American Medical Association, 2004, Vol 291, Issue 8, p955
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.291.8.955