Changes in Home Versus Clinic Blood Pressure With Antihypertensive Treatments A Meta-Analysis

Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare with the changes in clinic blood pressure (CBP). We searched PubMed using the terms "home or self-measured blood pressure," and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects. As there was significant heterogeneity in most of the outcomes, a random effects model was used for the meta-analyses. The mean changes (+/- SE) in CBP and HBP (systolic/diastolic) were -15.2 +/- 0.03/-10.3 +/- 0.03 mm Hg and -12.2 +/- 0.04/-8.0 +/- 0.04 mm Hg respectively, although there were wide varieties of differences in the reduction between HBP and CBP. The reductions in CBP were correlated with those of HBP (systolic BP; r = 0.66, B = 0.48, diastolic BP; r = 0.71, B = 0.52, P < 0.001). In 7 studies that also included 24-hour BP monitoring, the reduction of HBP was greater than that of 24-hour BP in systolic (HBP; -12.6 +/- 0.06 mm Hg, 24-hour BP; -11.9 +/- 0.04 mm Hg, P < 0.001). In 5 studies that included daytime and nighttime systolic BP separately, HBP decreased 15% more than daytime ambulatory BP and 30% more than nighttime ambulatory BP. In conclusion, HBP falls approximate to 20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP. (Hypertension. 2008;52:856-864.)