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Objective:Home blood pressure monitoring (HBPM) is more likely to reflect the patient's underlying blood pressure (BP), than measurements in the clinic. HBPM coupled with titration of medications under the guidance of doctors, is a viable intervention to control hypertension. The purpose of this study is to evaluate whether HBPM can increase the safety of the combination therapy of three or more different classes of antihypertensive drugs.Design and Method:We enrolled patients with severe (grade 3) hypertension, whose BP remain uncontrolled under combination treatment with standard doze of an angiotensin II receptor blocker and hydrochlorothiazide. The third drug amlodipine 5 mg daily was prescribed before patients were randomly assigned to the BP management only in clinic, or HBPM for 8 weeks. Office visits at baseline, 4th and 8th week were required to all the patients. Patients under HBPM management took BP measurement twice daily, with a memory-equipped device in the morning and evening, and allowed to titrate the doze following the doctor's instruction.Results:One hundred and eighty patients average aged 69 ± 8.4 years were enrolled. 20% patents in the HBPM group titrated amlodipine to 2.5 mg daily or stop taking if there is hypotension, or intolerance to the lowing BP. There was no difference in the BP control rate at 8th week office visit between two groups. However, The reductions in systolic BP were greater under office BP management at 8th weeks(P = 0.025). Patients under HBPM management complained less about dizziness or fatigue compared with office BP management in 8 weeks (P = 0.032).Conclusions:HBPM combined with titration under guidance of doctors encourages patient-centered care and reduces the side-affect caused by BP lowing. It has advantage to prevent hypotension in the management of severe hypertension need three kinds of antihypertensive drugs or above, thus improve the safety of the combined treatment, especially in the elderly.

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