Comparative assessment of target office blood pressure attainment and the results of its home monitoring in uncomplicated hypertension participants of real-life longitudinal PERFECT-BP study

Abstract

Purpose: to compare target office and normal home blood pressure (BP) attainment rates in uncomplicated hypertension (UH) participants of longitudinal program of compliance and BP control optimization by implementation of simplified treatment algorithm together with home BP monitoring (HBPM) and educational material in real-life setting (PERFECT-BP). Methods: Per protocol cohort of PERFECT-BP prospective observational study included 431 pts aged 57,6±0,5 years, 43,9% male, 17,2% with type 2 diabetes with new diagnosed (18,3%) or treated but uncontrolled UH (BP <200/120 mm Hg). Pts were provided with new standardized precalibrated automatic BP devices Microlife BP3AG1with individually selected cuff, written instructions for lege artis home BP measurements and educational materials. At visit 1, after training in the use of BP device and educational session, pts were prescribed or switched to 1 FDC tab pd of perindopril/amlodipine (dosed 5/5, 5/10, 10/5 or 10/10mg – at discretion of MDs) and instructed to perform HBPM twice pd (before breakfast and going to bed) for at least 7 consecutive days a week before each visit, and record it in a log. Step 2 of target office BP attainment (<140/90 mm Hg) was uptitration to the highest tolerated FDC dose, step 3 – plus indapamid-R 1.5 mg pd, step 4 – spironolactone 25 mg pd, step 5 – moxonidine or doxasosine. Office BP measurements were performed with standardized automatic Microlife BPW20. Results: In 6 months office SBP lowered from 165,7±0,7 to 131,1±0,5 mm Hg and DBP from 96,9±0,5 to 79,1±0,3 mm Hg (p<0,001). This was achieved with triple therapy in 29,9% pts, and ≥4 drugs in 2,3% pts. At 6 month home BP as a mean of 14±0,2consecutive measurements before the office visit was 129,5±0,4 mm Hg for SBP and 77,9±0,3 mm Hg for DBP. Though target office BP was attained in 347 (80,5%) of pts, it was associated with normal home BP (<135/85 mm Hg) only in 265 (61,5%) of pts while 82 (19%) had home BP and 17 (4%) of pts with elevated office BP had normal home BP. Both office and home BP stayed elevated in 67 (15,5%) of pts. Conclusion: In 23,6% of UN pts, who after 6 month antihypertensive treatment in real-life setting attained target office BP <140/90 mm Hg, it was associated with home BP (≥135/85 mm Hg) obtained by HBPM, while 20,2% of pts with elevated office BP attained normal home BP.