Management of hypertension in the elderly using home blood pressures

Objective To evaluate whether patient-measured home blood pressures alone can be used to manage hypertension in adults 65 years and older. Methods 40 hypertensive men and women, average age 73 +/- 6 years, were randomly assigned to one of two treatment decision groups. The 'home' group (N = 20) had blood pressure managed and medication changed according to measurements taken by the patient at home with the Omron HEM-702 semi-automatic oscillometric digital blood pressure monitor and the 'clinic' group (N = 20) had medication adjusted based upon readings taken by the project nurse in the clinic. In both groups, treated hypertensives had medications adjusted downward, while untreated hypertensives were started on a diuretic and/or ACE inhibitor and adjustments were made upward. To assess the efficacy of the home measurements as a means of hypertension management, 24-h ambulatory blood pressure averages, quality of life (From the QOL SF-36), and dosage of anti hypertensive medications were compared between the home and clinic groups over a three-month period. Results At baseline, the 'home' group had slightly higher ambulatory awake and sleep blood pressure than the 'clinic' group. At 3 months, the average awake and sleep ambulatory blood pressure for the 'home' group decreased to the level of the 'clinic' group. Values of the 'clinic' group did not change. In both groups, pressures of previously treated patients increased over the 3 months, while those that were previously untreated declined. However, this difference, to some extent, might be expected because the acceptable limit of pressure control (150/90 mmHg) was higher than many of the patients on medications; thus, their pressures could increase and still be considered controlled. Those patients who were previously untreated had their pressures decreased only to this level. The nurse-measured clinic blood pressures for the 'home' group began higher than that of the 'clinic' group and remained higher at the end of the study. Average home pressures of the 'home' group were consistently lower than nurse-measured clinic pressures over the 3-month study period, indicating a persistent 'white coat' effect. Both groups had similar changes in total quality of life scores. Decrease/discontinuance of antihypertensive medication was also achieved equally in both groups at the end of 3 months. Conclusion Home blood pressure monitoring alone may be as useful as clinic measurements for making treatment decisions in the elderly. (C) 2001 Lippincott Williams & Wilkins.