WHAT IS THE VALUE OF HOME (SELF) BLOOD-PRESSURE MONITORING IN PATIENTS WITH HYPERTENSIVE HEART-DISEASE

The acceptable maximal blood pressure values for patients monitoring t heir own blood pressure at home have not yet been determined. Risk of cardiovascular disease may be increased at lower blood pressure limits than those suggested by the World Health Organization (WHO) for clini c readings. We have investigated 25 patients with proven hypertensive small-vessel disease and compared self-monitored, ambulatory 24-h (ABP M) and clinic blood pressure measurements. The diagnosis of hypertensi ve small-vessel disease was based on clinical evidence of myocardial i schemia, angiographic exclusion of coronary heart disease, and abnorma l single-photon emission computed tomography (SPECT) thallium-201 myoc ardial scintigraphy. Mean self-monitored values were 143.4 +/- 13.6/84 .0 +/- 9.4 mm Hg (95% confidence intervals 137.6-149.0 mm Hg for systo lic and 80.1-87.9 mm Hg for diastolic blood pressure). Both home and a mbulatory daytime readings (141.2 +/- 11.8/83.9 +/- 10.2 mm Hg) were s ignificantly lower than the clinic readings by the physicians (clinic systolic, 169.2 +/- 16.5 mg; clinic diastolic, 95.0 +/- 11.6 mm Hg; P <.0001 v home and ambulatory readings). There was no significant diffe rence between home and ambulatory readings. Agreement between home and ambulatory values was much closer than for clinic v ABPM readings. Th e respective correlation coefficients for systolic values were r = 0.7 02 (home v ABPM; P <.0001) and r = 0.32 (clinic v ABPM; NS). For diast olic values correlation coefficients were r = 0.674 (home v ABPM; P <. 0002) and r = 0.574 (clinic v ABPM; P <.003) respectively. In conclusi on, the reported results suggest that the WHO suggested definition of hypertension (greater than or equal to 140/90 mm Hg) may be set too hi gh when blood pressures are measured by the patient at home. A cutoff value of < 135/85 mm Hg, as in ABPM, may be a more realistic upper lim it for self-monitoring. Am J Hypertens 1998; 11:813-819 (C) 1998 Ameri can Journal of Hypertension, Ltd.