Abstract 4424: The Changes in Home versus Clinic Blood Pressure with Antihypertensive Treatments: A Meta-Analysis
Background: 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).
Methods: 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 (N=6794) published before March 2008. A random effects model was used for the meta-analyses.
Results: 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 (N=6794). 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 (N=1246), 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 in which daytime and nighttime BP (N=801) were available, the changes in BPs are shown in Figure⇓. Antihypertensive drugs taken in the morning reduced evening BP marginally more than morning BP (morning BP; −10.8±0.08/−6.1±0.09 mmHg, evening BP −11.7±0.06/−7.4±0.06 mmHg); however, when the drugs were taken at night they reduced morning BPs much more (morning BP; −12.5±0.17/−7.5±0.20, evening BP; −5.6±0.12/−3.8±0.15 mmHg).
Conclusion: HBP falls about 20% less than CBP with antihypertensive treatments. The reductions of daytime and nighttime SBP were 15% and 30% smaller than that of HBP.