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November 24, 2004Blood Pressure MonitoringOpen Access

Antihypertensive treatment based on home or office blood pressure???the THOP trial

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Why the study?

Does antihypertensive therapy adjusted based on home blood pressure improve blood pressure control and left ventricular mass compared to office blood pressure in hypertensive patients?

Population

400 hypertensive patients with sitting diastolic blood pressure (DBP) >95 mmHg

Comparison

Blood pressure-lowering therapy adjusted in a… vs Blood pressure-lowering therapy adjusted in a…

Design

RCT, randomized

Authors

EHElly Den HondJSJan A. StaessenHCHilde Celis

Discussion

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Overview

Home BP-guided therapy risks poorer control despite lower intensity and cost; challenges assumptions favoring it over office monitoring for titration.

Key Points

  • To assess whether adjusting antihypertensive drug therapy based on home self-measurements differs from conventional office blood pressure monitoring.
  • Randomized clinical trial conducted in 400 hypertensive patients with sitting diastolic blood pressure >95 mmHg.
  • Blood pressure-lowering treatment was adjusted in a stepwise manner based on either self-measured home DBP or conventional office DBP.
  • Guidance by home blood pressure resulted in less intensive drug treatment and marginally lower costs, but led to less blood pressure control qualitatively compared to office guidance.
  • No significant differences were observed in left ventricular mass between the home and office monitoring groups.
  • Self-measurement at home successfully identified patients with white-coat hypertension.

Structured PICO

Does antihypertensive therapy adjusted based on home blood pressure improve blood pressure control and left ventricular mass compared to office blood pressure in hypertensive patients?

P
Population
400 hypertensive patients with sitting diastolic blood pressure (DBP) >95 mmHg
I
Intervention
Blood pressure-lowering therapy adjusted in a stepwise manner based on self-measured DBP at home
C
Comparator
Blood pressure-lowering therapy adjusted in a stepwise manner based on conventional DBP measured at the doctor's office
O
Outcome
Intensity of drug treatment, costs, blood pressure control, and left ventricular masssurrogate

Home blood pressure monitoring for adjusting antihypertensive therapy leads to less intensive treatment and lower costs but poorer blood pressure control compared to office-based monitoring.

Cite This Study

Hond et al. (2004) studied this question.

synapsesocial.com/papers/6a880c4e04120b0d52eb3a99https://doi.org/10.1097/00126097-200412000-00008
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Antihypertensive Treatment Based on Blood Pressure Measurement at Home or in the Physician's Office<SUBTITLE>A Randomized Controlled Trial</SUBTITLE>2004 · 291 citations
  2. 2Cardiovascular Prognosis of "Masked Hypertension" Detected by Blood Pressure Self-measurement in Elderly Treated Hypertensive Patients2004 · 850 citations
  3. 3European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement2003 · 1,665 citations
  4. 4Home blood pressure normalcy: The Didima study2000 · 51 citations
  5. 5The Tecumseh Blood Pressure Study1990 · 58 citations