Impact of home blood pressure monitoring on blood pressure control in older individuals: a French randomized study

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Abstract

Objective:

Home blood pressure (BP) monitoring is one of the tools recommended in hypertension management. However, its influence in older adults is seldom investigated. We aimed to assess whether regular home BP monitoring leads to a reduction of BP and an improvement in hypertension control in older adults.

Methods:

In a 24-month trial, individuals aged 73–97 years were randomized in a control (office and home BP measured at 0, 12, and 24 months) or an intervention (office measured at 0, 12, and 24 months; home BP measured every 3 months) group. The primary outcome was the difference in means office BP over 24 months in hypertensive patients. Secondary outcomes included differences in mean home BP over follow-up in hypertensive patients, and frequency of hypertension and of drug use at 24 months in the total sample. Intention-to-treat analyses comprised 1733 persons, among which 1043 were hypertensive.

Results:

Hypertensive patients in the intervention group experienced a significantly greater fall in office systolic BP (SBP) [mean between-group difference −2.1 mmHg, 95% confidence interval (CI) −4.1; −0.2, P = 0.03], home SBP (mean between-group difference −3.4, 95% CI −4.8; −2.1, P < 0.0001), and home diastolic BP (mean between-group difference −1.1, 95% CI −1.8; −0.4, P = 0.002) than those in the control group, in the main model. No overall differences were observed for office diastolic BP (P = 0.74), frequency of hypertension (P = 0.92), or drug use (P = 0.51) over time. Similar results were observed after adjustment for known predictors of BP though attenuated for office SBP (P = 0.07).

Conclusion:

Regular home BP monitoring every 3 months without co-intervention results in small but greater reductions of BP over time. Further research in large trials focused on older adults is needed to confirm the effectiveness of this intervention in a variety of settings.

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