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

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Trials

Background:

• Hypertension diagnosis and management traditionally rely on office blood pressure (BP) measurements.
• Self-measurement of BP at home offers an alternative or complementary approach.
• The impact of home BP monitoring on treatment intensity and patient outcomes requires further investigation.

Purpose of the Study:

• To compare the effectiveness of stepwise BP-lowering therapy guided by home BP measurements versus office BP measurements in hypertensive patients.
• To assess the impact of each strategy on drug treatment intensity, costs, BP control, and left ventricular mass.
• To evaluate the utility of home BP monitoring in identifying white-coat hypertension.

Main Methods:

• Randomized clinical trial involving 400 hypertensive patients with sitting diastolic blood pressure (DBP) >95 mmHg.
• Stepwise adjustment of BP-lowering therapy based on either self-measured home DBP or conventionally measured office DBP.
• Assessment of treatment intensity, costs, BP control, and left ventricular mass.

Main Results:

• Home BP-guided therapy resulted in less intensive drug treatment and marginally lower costs.
• Less optimal blood pressure control was observed with home BP-guided therapy compared to office-guided therapy.
• No significant differences in left ventricular mass were found between the two groups.
• Home BP self-measurement effectively identified patients with white-coat hypertension.

Conclusions:

• A stepwise strategy for BP evaluation, incorporating home BP self-measurement and ambulatory monitoring, complements conventional office BP measurements.
• Home BP monitoring can aid in identifying white-coat hypertension and potentially guide treatment adjustments.
• While offering benefits like reduced treatment intensity, home BP monitoring requires careful integration with other measurement methods for optimal hypertension management.