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Abstract
Background
It is still unclear how self-measured home blood pressure (BP) evolves over time in treated hypertensive patients, and the usefulness of home BP based treatment is under debate.
Methods
The patients whose anti-hypertensive medications had not been changed at least 6 months were enrolled. They measured home BP at enrollment and at study end. The patients were classified into controlled hypertension (CH), hypertension with white coat effect (WCH), hypertension with reverse white coat effect (RWCH), and uncontrolled hypertension (UH), based on their clinic and home BP. Their home BP profiles were reflected in the patients' treatments, instead of relying solely on clinic BP.
Results
Ninety patients (mean age, 56.5 ± 9.9; male, 57.8%) were analyzed and mean follow-up duration was 34.1 ± 3.6 months. CH, WCH, RWCH, and UH patients were 33.3% (30 patients), 37.8% (34 patients), 5.6% (5 patients), and 23.3% (21 patients), respectively at enrollment. Almost all CH and WCH patients remained in normal range of home BP whereas about half of RWCH and UH patients moved to CH or WCH. As a result, the proportion of RWCH and UH decreased at the end of follow-up. Overall clinic and home BP reduced significantly in all groups. Clinic BP declined significantly in WCH and UH, whereas home BP declined significantly in RWCH and UH. That means the BP profiles shifted toward more reasonable states.
Figures and Tables
Table 1
Baseline characteristics of the study population
Values are presented as number (%) or mean ± standard deviation.
Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria (for obesity, a waist circumference > 90 cm in male or > 80 cm in female). We defined cardiovascular risk factors as cigarette smoking, DM (fasting blood glucose ≥126mg/dL or taking oral hypoglycemic agent or under insulin therapy), dyslipidemia (total cholesterol ≥240 mg/dL or LDL cholesterol ≥160 mg/dL or HDL cholesterol < 40 mg/dL in male, < 50 mg/dL in female), obesity (BMI ≥25 kg/m2 or waist circumference > 90 cm in male, > 80 cm in female), physical inactivity (exercise < 2 hours/week), old age (≥45 years-old in male, ≥55 years-old in female) and familial history of premature cardiovascular disease (< 55 years-old in the first relative male, < 65 years-old in the first relative female).
CH, controlled hypertension; WCH, hypertension with white coat effect; RWCH, hypertension with reverse white coat effect; UH, uncontrolled hypertension; BMI, body mass index; LDL, low-density lipoprotein; HDL, high-density lipoprotein; DM, diabetes mellitus.
*p-value < 0.05 in inter-group comparison using Fisher's exact test.
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