Measurement and evaluation of home blood pressure monitoring with particular emphasis on evaluating anti-hypertensive effects using a home blood pressure distribution diagram

Tight blood pressure control over a long period is important to prevent end-organ damage to the brain, heart, and kidneys, and to avoid the complications of hypertension. Control requires an accurate evaluation of treatment through an appropriate monitoring of home blood pressure. In this study, we evaluated a method of home blood pressure monitoring, in which we propose a home blood pressure distribution diagram to evaluate the effectiveness of anti-hypertensive therapy. 1 ) In home blood pressure measurements, the first reading was high, while the second and third readings were essentially similar and thus stable. 2 ) Home blood pressure showed great daily variations, thus necessitating the use of the mean blood pressure over a fixed period, and not the individual blood pressure readings. The mean (morning, mid-day, and evening) over a one-week period was unstable, while the readings were stable over a three-week period. 3 ) The diagrams showing the distribution of home blood pressure measurements obtained in the morning and at night over a long period allowed the degree of early morning hypertension and the effectiveness of long-term blood pressure control to be assessed, and thus were useful for selecting anti-hypertensive agents. 4 ) In elderly patients, a mid-day systolic pressure of 100 mmHg or less (particularly 90 mmHg or less) resulted in the onset of symptoms of excessive hypotensive effects, such as lightheadedness and fainting, which affected ADL and QOL. 5 ) Because of great daily variations, it is difficult to achieve the blood pressure target of 130/80 mmHg or less in patients with hypertension associated with diabetes mellitus or renal insufficiency. 6 ) The home blood pressure distribution diagram facilitated an understanding of the status of anti-hypertensive therapy by patients, and was useful for motivating patients to continue treatment.