Dallas, TX - In a randomized study that explores a possible way to prevent unnecessary drug therapy aimed at "white-coat" hypertension, patients were more likely to reach their blood-pressure goals and used fewer medications when treatment decisions were based on BP measurements they made themselves, compared with those obtained in the office by providers [1].

"Our findings support the use of self blood-pressure measurements in addition to [office-based] blood-pressure measurements in regular clinical care to improve overall BP control and to prevent unnecessary treatment prescriptions with associated healthcare costs," write the authors, led by Dr Willem J Verberk (University Hospital Maastricht, the Netherlands).

On the other hand, according to the group, treatment guided by self measurement didn't control 24-hour ambulatory BP as effectively as office-reading-guided therapy, so the study doesn't provide "hard evidence" that the self-measuring strategy is safe.

The Home vs Office Measurement, Reduction of Unnecessary Treatment Study (HOMERUS) is published in the December 2007 issue of Hypertension.

The trial randomized 430 adults with >139 mm Hg systolic and/or >89 mm Hg diastolic BP, as measured by providers, to conventional stepwise antihypertensive therapy guided by either patient self-measured BP or office-based BP readings. Prescribing physicians were blinded as to which group patients belonged.

Over a median follow-up of about 350 days, the self-measuring patients required an average of 1.47 steps in drug therapy to achieve BP control, compared with 2.48 steps in the office-based group (p<0.001). Significantly fewer self-measuring patients remained above the target BP despite the use of three different antihypertensive agents (9% vs 18%, p=0.01).

Differences in ambulatory blood pressure, however, favored the group with office-based BP-guided management. Their mean 24-hour ambulatory pressures by the end of the study were 123.8/76.1 mm Hg, as compared with 125.9/77.2 mm Hg for the self-measuring patients (p=0.04 for systolic and p=0.05 for diastolic).

The monthly cost of medication per 100 patients was $3023 and $4147, respectively (p<0.001); visits to the physician were as frequent and therefore cost about the same in both groups. When total costs were adjusted for various other charges, they were still significantly lower in the self-measuring group (p=0.03), according to Verberk et al.

Both groups showed significant improvements in LV mass index and urinary microalbumin levels over the course of the study, but to similar degrees.

That ambulatory pressures were higher in the self-measuring patients by the end of the study suggests, if extrapolated long term, that this group might experience more cardiovascular events than those managed according to office-based readings. Therefore, write Verberk et al, large outcomes trials with longer follow-up are needed "to confirm or refute the significance of our present findings."