Home blood pressure vs. clinic blood pressure measurement-based follow up in type II diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial

Abstract

Bakground and objectiveTo compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. Patients and methodsMulticentre, prospective, randomized, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140mmHg without relevant renal disease were randomized to one of two follow-up strategies: (1) standard follow up, with a clinic BP target <140/90mmHg and (2) self-monitoring home BP (SMHBP)-based follow up, with a BP target <135/85mmHg. Biochemical standard blood variables, albuminuria, and 24-h ambulatory BP monitoring were performed at entry, 12 and 24 months. The main outcome measurement was 24-h ambulatory systolic BP variation. Albuminuria change was analyzed as a secondary outcome. Results116 patients were analyzed (mean age: 66.8 years). Mean systolic ambulatory 24-h BP change in two years was 3.9mmHg (95% CI 1.8–6.1). We did not find significant differences between both groups (p=0.706). Similarly, no differences were found when we compared other ambulatory BP values. Initial albuminuria was similar in both groups and did not significantly changed throughout the follow-up period. ConclusionIn type 2 diabetics without relevant nephropathy a SMHBP- based follow up was equivalent to a standard clinic-based BP follow up in BP and albuminuria control.