ANTIHYPERTENSIVE TREATMENT BASED ON CONVENTIONAL OR AMBULATORY BLOOD-PRESSURE MEASUREMENT - A RANDOMIZED CONTROLLED TRIAL

Context.-Ambulatory blood pressure (ABP) monitoring is used increasing ly in clinical practice, but how it affects treatment of blood pressur e has not been determined. Objective.-To compare conventional blood pr essure (CBP) measurement and ABP measurement in the management of hype rtensive patients. Design.-Multicenter, randomized, parallel-group tri al. Setting.-Family practices and outpatient clinics at regional and u niversity hospitals. Participants.-A total of 419 patients (greater th an or equal to 18 years), whose untreated diastolic blood pressure (DB P) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP o r ABP arms. Interventions.-Antihypertensive drug treatment was adjuste d in a stepwise fashion based on either the average daytime (from 10 A M to 8 PM) ambulatory DBP (n=213) or the average of 3 sitting DBP read ings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at ( 80-89 mm Hg), or below (<80 mm Hg) target, 1 physician blinded to the patients' randomization intensified antihypertensive treatment, left i t unchanged, or reduced it, respectively. Main Outcome Measures.-The C BP and ABP levels, intensity of drug treatment, electrocardiographic a nd echocardiographic left ventricular mass, symptoms reported by quest ionnaire, and cost. Results.-At the end of the study (median follow-up , 182 days; 5th to 95th percentile interval, 85-258 days), more ABP th an CBP patients had stopped antihypertensive drug treatment (26.3% vs 7.3%; P<.001), and fewer ABP patients had progressed to sustained mult iple-drug treatment (27.2% vs 42.7%; P<.001). The final CBP and 24-hou r ABP averaged 144.1/89.9 mm Hg and 129.4/79.5 mm Hg in the ABP group and 140.3/89.6 mm Hg and 128.0/79.1 mm Hg in the CBP group. Left ventr icular mass and reported symptoms were similar in the 2 groups. The po tential savings in the ABP group in terms of less intensive drug treat ment and fewer physician visits were offset by the costs of ABP monito ring. Conclusions.-Adjustment of antihypertensive treatment based on A BP monitoring instead of CBP measurement led to less intensive drug tr eatment with presentation of blood pressure control, general well-bein g, and inhibition of left ventricular enlargement but did not reduce t he overall costs of antihypertensive treatment.