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(Hypertension. 2007;50:1019.)
© 2007 American Heart Association, Inc.

Original Articles

Self-Measurement of Blood Pressure at Home Reduces the Need for Antihypertensive Drugs

A Randomized, Controlled Trial

Willem J. Verberk; Abraham A. Kroon; Jacques W.M. Lenders; Alfons G.H. Kessels; Gert A. van Montfrans; Andries J. Smit; Paul-Hugo M. van der Kuy; Patricia J. Nelemans; Roger J.M.W. Rennenberg; Diederick E. Grobbee; Frank W. Beltman; Manuela A. Joore; Daniëlle E.M. Brunenberg; Carmen Dirksen; Theo Thien; Peter W. de Leeuw for the Home Versus Office Measurement, Reduction of Unnecessary Treatment Study Investigators

From the Cardiovascular Research Institute Maastricht, Maastricht University, and the Departments of Internal Medicine (W.J.V., A.A.K., R.J.M.W.R., P.W.d.L.), Medical Technology Assessment and Epidemiology (A.G.H.K., M.A.J., D.E.M.B., C.D.), Clinical Epidemiology (P.J.N.), and Clinical Pharmacy (P.-H.M.v.d.K.), University Hospital Maastricht, Maastricht, The Netherlands; Department of General Internal Medicine (J.W.M.L., T.T.), Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Internal Medicine (G.A.v.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Internal Medicine (A.J.S.) and General Practice (F.W.B.), University Medical Center Groningen, Groningen, The Netherlands; and the Julius Center for Health Sciences and Primary Health Care (D.E.G.), University Medical Center Utrecht, Utrecht, The Netherlands.

Correspondence to Willem J. Verberk, Department of Internal Medicine, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail willem.verberk{at}intmed.unimaas.nl

It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (n=216) or office pressures (OPs; n=214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (–6.5 g/m² versus –5.6 g/m²; P=0.72), or in median urinary microalbumin concentration (–1.7 versus –1.5 mg per 24 hours; P=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.

Key Words: blood pressure • hypertension • self-measurements • home monitoring • ambulatory blood pressure measurement • treatment

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