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Out-of-office blood pressure (BP) measurement using home BP (HBP) or ambulatory BP (ABP) monitoring is often necessary for the accurate evaluation of hypertension. These methods have several similarities but also have major differences. Therefore, they are regarded as complementary, and there is uncertainty on how they should be applied in clinical practice. This study compared hypertension management based on clinic and ABP measurements or on HBP measurements alone.Untreated subjects with elevated BP were randomized to treatment initiation and titration based on clinic and ABP measurements or on HBP measurements alone. Target organ damage was assessed at baseline and after 1 year of treatment with echocardiographic left ventricular mass index (primary endpoint), pulse wave velocity, and urinary albumin excretion.A total of 145 subjects were randomized, and 116 completed the study (mean age = 50.7±10.5 years; 69 men (59%); mean follow-up = 13.4±1.4 months). There was no difference between the 2 arms in treatment-induced change in left ventricular mass index (mean difference = 0.50±1.11g/m2; 95% confidence interval (CI) = −1.70 to 2.70). Moreover, there was no difference between the 2 arms in treatment-induced changes in pulse wave velocity (mean difference = −0.16±0.42 m/s; 95% CI = −0.99 to 0.66), urinary albumin excretion (mean difference = −0.85±4.28mg/dl; 95% CI = −9.37 to 7.66), HBP and ABP levels, and hypertension control rates.These data suggest that HBP monitoring alone is as reliable as combined clinic and ABP measurements in monitoring the effects of antihypertensive drug treatment on BP and preclinical target organ damage.