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Impact of home blood pressure monitoring on blood pressure control in older individuals: a French randomized study

Tzourio, Christophe; Hanon, Olivier; Godin, Ophélia; Soumaré, Aicha; Dufouil, Carole

doi: 10.1097/HJH.0000000000001191
ORIGINAL PAPERS: Therapeutic aspects

Objective: Home blood pressure (BP) monitoring is one of the tools recommended in hypertension management. However, its influence in older adults is seldom investigated. We aimed to assess whether regular home BP monitoring leads to a reduction of BP and an improvement in hypertension control in older adults.

Methods: In a 24-month trial, individuals aged 73–97 years were randomized in a control (office and home BP measured at 0, 12, and 24 months) or an intervention (office measured at 0, 12, and 24 months; home BP measured every 3 months) group. The primary outcome was the difference in means office BP over 24 months in hypertensive patients. Secondary outcomes included differences in mean home BP over follow-up in hypertensive patients, and frequency of hypertension and of drug use at 24 months in the total sample. Intention-to-treat analyses comprised 1733 persons, among which 1043 were hypertensive.

Results: Hypertensive patients in the intervention group experienced a significantly greater fall in office systolic BP (SBP) [mean between-group difference −2.1 mmHg, 95% confidence interval (CI) −4.1; −0.2, P = 0.03], home SBP (mean between-group difference −3.4, 95% CI −4.8; −2.1, P < 0.0001), and home diastolic BP (mean between-group difference −1.1, 95% CI −1.8; −0.4, P = 0.002) than those in the control group, in the main model. No overall differences were observed for office diastolic BP (P = 0.74), frequency of hypertension (P = 0.92), or drug use (P = 0.51) over time. Similar results were observed after adjustment for known predictors of BP though attenuated for office SBP (P = 0.07).

Conclusion: Regular home BP monitoring every 3 months without co-intervention results in small but greater reductions of BP over time. Further research in large trials focused on older adults is needed to confirm the effectiveness of this intervention in a variety of settings.

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aUniversity Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux

bUniversity Paris Descartes

cDepartment of Geriatrics, Broca Hospital, Paris

dINSERM, UMR_S 1136, Institut Pierre Louis d’Epidemiologie et de Sante Publique, Paris, France

Correspondence to Christophe Tzourio, Inserm U1219, University of Bordeaux, 146 rue Léo Saignat-Case 11, 33076 Bordeaux, Cedex, Bordeaux, France. Tel: +33 557571659; fax: +33 547304209; e-mail: christophe.tzourio@u-bordeaux.fr

Abbreviations: 3C, the Three City study; BP, blood pressure; CI, confidence interval; HBP, home blood pressure; HBPM, home blood pressure monitoring; HDBP, home diastolic blood pressure; HSBP, home systolic blood pressure; ITT, intention-to-treat; OBP, office blood pressure; OBPM, office blood pressure monitoring; ODBP, office diastolic blood pressure; OSBP, office systolic blood pressure; SD, standard deviation

Received 18 February, 2016

Revised 14 October, 2016

Accepted 26 October, 2016

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

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