Measuring blood pressure at home lowers drug need

NEW YORK (Reuters Health) - The use of drugs to lower high blood pressure (hypertension) as well as the associated costs are reduced when the prescription of antihypertensive medication is based on self-measurements of blood pressure, rather than office measurements, without loss of control over blood pressure or organ damage, according to findings published in the medical journal Hypertension.

As the treatment guidelines for lowering blood pressure become more "stringent," the use of drugs and their associated costs are noticeably rising, Dr. Willem J. Verberk, of University Hospital Maastricht, the Netherlands, and colleagues point out. "This calls for proper diagnosis and careful selection of patients in whom treatment is really indicated. It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure."

To investigate, the researchers randomly assigned 430 hypertensive patients to receive treatment either based on self-measured blood pressure or based on office-measured pressures over the course of one year. Blood pressure was also measured by 24-hour monitoring at the start and end of the trial.

Patients in the self-measured group used significantly less medication than those in the office-measured group. The average treatment costs in the self-measured group were also lower compared with those in the office-measured group, at $3,222 versus $4,420 per 100 patients per month.

No significant differences were observed between the self-measured and the office-measured groups in blood pressure values or changes indicating kidney or heart damage.

The authors note though that the 24-hour ambulatory blood pressure values at the end of the trial were significantly higher in the self-measured group than in the office-measured group.

The overall findings support the use of self-measured blood pressure as an addition to office measurements to improve the control of hypertension and prevent unnecessary drug treatment and associated costs, Verberk and colleagues conclude.

"However, because the ambulatory blood pressure was less well controlled in patients from the self-pressure group than in patients from the office-pressure group, the present study did not provide hard evidence that it is safe to base antihypertensive treatment on self-blood pressure measurement readings," they note.

SOURCE: Hypertension, December 2007.