Achieving blood pressure control with monotherapy: real-world evidence from office and home blood pressure measurements

Despite guidelines discouragement, antihypertensive monotherapy (AH-mono) remains widely used. This study assessed AH-mono prevalence and blood pressure control rates based on office and home measurements (OBP/HBPM) using contemporary targets (<130/80 mmHg). Three distinct cohorts undergoing OBP/HBPM assessments between July 2018 and July 2024 were analyzed: cohort 1 ( n = 63 164) included treated patients with a single OBP/HBPM measurement; cohort 2 ( n = 5676) comprised treated patients with two OBP/HBPM assessments at different time points; and cohort 3 ( n = 974) involved individuals with OBP/HBPM measurements before and after initiating antihypertensive therapy. The prevalence of AH-mono was 42.7% in cohort 1, 36.6 and 32.4% in cohort 2, and 50.7% in cohort 3. Among those receiving AH-mono, OBP/HBPM control rates were 8.5% in cohort 1, 6.7 and 7.3% in Cohort 2, and 7.7% in cohort 3. These real-world findings highlight the persistent high prevalence of AH-mono despite its limited efficacy, with less than 10% of patients achieving blood pressure control.