Antihypertensive treatment based on conventional or home blood pressure measurement - the thop trial

Abstract

The hypothesis that self-measurement of BP at home (HBP) compared with conventional clinic measurement (CBP) would improve the management of hypertension was tested in a multicenter trial. Using a double-blind design, hypertensive patients (conventional DBP ≥ 95 mm Hg) were randomized to reach a target DBP from 80 through 89 mm Hg either on conventional measurement (CBP group) or on self-measurement at home (HBP group). Antihypertensive drug treatment was started at randomization in all patients and was stepwise adjusted at 7 follow-up visits. Net between-group differences were calculated by substracting mean changes from baseline in the CBP group (n=197) from those in the HBP group (n=203). All patients also underwent 24-h ABP monitoring at randomization and at the end of follow-up. Characteristics at baseline were similar in the 2 groups. Antihypertensive drug treatment was discontinued more frequently in HBP than CBP patients (25.2 vs. 12.3%, P=0.001). Slightly fewer HBP patients progressed to multiple drug treatment (38.7 vs. 46.4%, P=0.08). At the end of follow-up (median, 354 days), BP was higher (P<0.001) in HBP than CBP patients, regardless of the technique of BP measurement. The final between-group differences averaged: for CBP, 6.7/3.5 mm Hg (P<0.001); for HBP, 4.9/2.9 mm Hg (P<0.001); for daytime ABP, 5.1/3.1 mm Hg (P<0.001). The mean changes from baseline in electro- and echocardiographic indexes did not differ between HBP and CBP patients: for Sokolow-Lyon index, -0.159 vs. -0.080 mV (n=353, P=0.27); for LVMI, -16.1 vs. -6.8 g/m’b2 (n=50, P=0.16); for the E/A Doppler ratio, -0.04 vs. +0.16 (n=48, P=0.09). Compared to CBP, adjustment of antihypertensive therapy according to HBP led to less intensive drug treatment, but also to less BP reduction. Our findings suggest that with lower diagnostic thresholds than implemented in our trial, HBP measurements might be complementary to CBP and ABP in the management of hypertensive patients.