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Hypertension

Hypertension- Role of Home BP Monitoring

The American Heart Association in late 2004 released an update in previous guidelines promoting the use of out of office blood pressure measurements to more accurately measure blood pressure.

One study to examine the role of home blood pressure measurements was the Self-Measurement of Blood Pressure at Home in the Elderly: Assessment and Follow-up (SHEAF), published in the Journal of the American Medical Association in March 2004.

This large study enrolled almost 5000 patients who had measurements of both office and home blood pressures at entry. Subsequent therapy was at the discretion of the GP. Therapy was not guided by the initial measurements.

After a mean followup of over three years, the cardiovascular event incidence was 22.2 per 1000 patient years.

They found

  • the lowest risk was in those with initially normal home and office BP measurements.
  • a group with raised home BP measurements and normal office BP measurements had the same increased risk of events as those with raised home and office BP measurements. This group was referred to those with "masked hypertension".
  • those with normal home BP measurements but raised office blood pressure had only slightly higher event rates.

This suggests home BP measurements can be useful to stratify risk, including confirmation of lower risk in those with "white-coat hypertension".

Hitesh Patel, Cardiologist
14th May, 2005

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