Antihypertensive Treatment Based on Conventional or Ambulatory Blood Pressure Measurement

Abstract

Context. —Ambulatory blood pressure (ABP) monitoring is used increasingly in clinical practice, but how it affects treatment of blood pressure has not been determined. Objective. —To compare conventional blood pressure (CBP) measurement and ABP measurement in the management of hypertensive patients. Design. —Multicenter randomized, parallel-group trial. Setting —Family practices and outpatient clinics at regional and university hospitals. Participants. —A total of 419 patients (-18 years), whose untreated diastolic blood pressure (DBP) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP or ABP arms. Interventions. —Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the average daytime (from 10 am to 8 pm) ambulatory DBP (n=213) or the average of 3 sitting DBP readings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below ( Main Outcome Measures. —The CBP and ABP levels, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and cost. Results. —At the end of the study (median follow-up, 182 days; 5th to 95th percentile interval, 85-258 days), more ABP than CBP patients had stopped anithypertensive drug treatment (26.3% vs 7.3%; P P Conclusions. —Adjustment of antihypertensive treatment based on ABP monitoring instead of CBP measurement led to less intensive drug treatment with preservation of blood pressure control, general well-being, and inhibition of left ventricular enlargement but did not reduce the overall costs of antihypertensive treatment.