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Drug-induced drop in home BP ‘20% lower than clinic BP’

Hypertension 2008; 52: 856–864

A meta-analysis of blood pressure (BP) changes on antihypertensive treatment has found that home and 24-hour ambulatory measurements consistently fall less than clinic BP measurements.

The study authors say their findings will be valuable for clinicians when interpreting non-clinic BP measures as a guide to the efficacy of antihypertensive therapy.

Joji Ishikawa (Columbia University Medical Center, New York, USA) and team searched the literature for studies reporting home- or self-measured changes in systolic or diastolic BP induced by antihypertensive drugs. Thirty studies, with 6794 subjects, were included in the meta-analysis.

Writing in the journal Hypertension, Ishikawa et al report that drug-induced changes in home BP were around 20% smaller than those of clinic BP (–12.2/–8.0 vs –15.2/–10.3 mm Hg).

The changes in home and clinic BPs were linearly related, and the authors believe that the difference in BP reduction between clinic and home measurements was attributable to the difference in baseline BP levels.

They also found that 24-hour ambulatory systolic BP changed less than home systolic BP (–11.9 vs –12.6 mm Hg), most likely due to the influence of work and other out-of-home environments.

Finally, the differing effects on clinic and home BP were similar for calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers, and also for placebo or control groups.

“Home BP falls ~20% less than clinic BP with antihypertensive treatments” Ishikawa et al conclude. “Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP.”

In an accompanying editorial, Lawrence Krakoff (Mount Sinai School of Medicine, New York, USA) commented that the meta-analysis is “timely” given the increasing use and acceptance of home BP monitoring.

“As home pressure measurements become widely used to assess the effect of treatment, even perhaps replacing clinic measurement, clinicians need to know the strengths and limitations of this advance for better management of hypertension,” he remarked.

Read the abstract