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

Ishikawa, Joji; Carroll, Deirdre J.; Kuruvilla, Sujith; Schwartz, Joseph E.; Pickering, Thomas G.

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 ≈20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP.

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Academic Units
Center for Behavioral Cardiovascular Health
Published Here
July 24, 2016