Is antihypertensive treatment based on home blood pressure recommended rather than that based on office blood pressure in adults with essential hypertension? (meta-analysis)

Self-measured blood pressure (BP) at home, that is, home BP, is a stronger prognosticator than office BP. However, some physicians seem to think that office BP measurement is sufficient to manage hypertension. We aimed to assess whether interventions based on using home BP affect clinical outcomes including BP levels when compared with usual care based on office BP. Using the PubMed and the Cochrane Library databases (until July 2017), we searched randomized controlled trials comparing home BP-based treatment to usual care in adults with essential hypertension aged ≥18 years in an area with an established medical system. Outcomes were (1) cardiovascular events and related deaths and (2) changes in ambulatory BP levels. For outcomes of cardiovascular events and related deaths, there were no appropriate studies for the present meta-analysis. For outcomes of BP change, the analysis based on all 12 studies found by our search showed that home BP-based treatment was significantly associated with a 1.18 mmHg larger reduction in the average ambulatory systolic BP than the control group (P = 0.04). However, a high heterogeneity was observed (I2 = 75%, P < 0.0001). Based on nine studies employing a lower target BP for home BP than for office BP, the differences in the averages of the ambulatory systolic/diastolic BP changes between the two groups were 3.62/2.16 mmHg, respectively (P < 0.0001). No significant heterogeneity was observed (I2 = 0%, P ≤ 0.59). Home BP-based treatment is strongly recommended to control BP, especially in the setting of a lower home BP target than an office BP target level.