PREDICTABILITY OF LOW OFFICE SYSTOLIC BLOOD PRESSURE FOR LOW HOME SYSTOLIC BLOOD PRESSURE IN THE PATIENT CONSIDERED FOR DOWN TITRATION OF ANTIHYPERTENSIVE MEDICATION

Abstract

Objective: With the recent trend of intensive blood pressure (BP) control strategy, some patients are considered for down-titration when office systolic BP (SBP) go below 120 mmHg. Considering many factors related to visit to visit BP variability and the discrepancy between office and out of office BPs, the predictability of low office SBP for low home SBP needs to be studied. Design and method: In a retrospectively study design, during 2020.09.01∼2022.05.31, patient recommended for home blood pressure monitoring (HBPM) for the decision for down-titration by physician's discretion. Physician's discretion was regarded to be present when OSBP < 120 mmHg. Additionally, patient data in the next visit in whom incidental home SBP were < 120mmHg were added for the analysis for the predictability and concordance of low office SBP for the low home SBP in the next visit, and the sustainability of the low office SBPs were calculated. Results: Among 82 enrolled patients, 69 patients with complete pre-HBPM office SBP, office SBP and HBPM data at the next visit were available were analyzed. Home SBP (112.1±8.9 mmHg, p<0.001 for both) were significantly lower than pre-HBPM (123.0±17.8 mmHg) office SBP and office SBP at the next visit (122.5±12.9 mmHg). Among 33 patients with low pre-HBPM office SBP, 28 patients (85.5%) showed low home SBP. Low pre-HBPM office SBP were sustained in 17 patients (51.5%). Among 59 patients with low home SBP, 31 patients (52.5%) were pre-HBPM office SBP were 120 mmHg or higher. At the time of HBPM, overall concordance rate between low office SBP and low home SBP were 33.3% (23 patients). Conclusions: The predictability of office SBP for low home SBP is good enough to decide down-titration at the next visit and the low office SBP were sustained in more than a half. But a half of low home SBP patients is detected incidentally by HBPM. Whether routine HBPM for down-titration will be needed for patients’ safety needs further study.