Efficacy of isolated home blood pressure monitoring for blood pressure control: randomized controlled trial with ambulatory blood pressure monitoring - MONITOR study

Background Rates of control of hypertension remain unsatisfactory worldwide and simple methods to encourage patients to adhere to treatments are still necessary. In this randomized controlled trial, we evaluated the efficacy of a protocol of home blood pressure monitoring (HBPM), without medication titration, to improve BP assessed by ambulatory BPM (ABPM). Methods Patients with hypertension under drug treatment and with uncontrolled BP at office and by 24-h ABPM were randomly assigned to HBPM or usual care. The treatment was not modified during the trial. Follow-up visits were conducted at 7 and 30 days after randomization, and at 60 days to assess the outcome. Deltas between baseline and final ABPM measurements were calculated for 24-h, nightly and daily ambulatory SBP and DBP. Results Of 558 patients screened, 136 fulfilled the eligibility criteria and were randomized, and 121 (89%) completed the trial. The between groups deltas (95% confidence interval) of variation of 24 h, nightly and daily SBP were 5.4 (0.9-9.8) (P=0.018), 10.9 (2.9-18.9) (P=0.012) and 4.4 mmHg (-0.1 to 8.8) (P=0.055), respectively; the corresponding deltas for DBP were 4.5 (1.6-7.4) (P=0.003), 3.4 (0.4-6.3) (P=0.025) and 5.8 mmHg (2.5-9.0) (P=0.001), respectively. At the end of the trial, 32.4% of patients of the HBPM groups and 16.2% of the control group had 24-h SBP less than 130/80 mmHg (P=0.03). Conclusion A protocol of HBPM without medication titration enhances the control of BP assessed by ABPM. J Hypertens 30:75-80 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.