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Treatment of Hypertension Based on Home or Office Blood Pressure - THOP
Description:
The goal of the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) trial was to evaluate self-measurement versus conventional office measurement of blood pressure (BP) as guides to initiate and titrate antihypertensive drug treatment.
Hypothesis:
The trial was powered to detect BP differences of 5 mm Hg for systolic BP (SBP) or 2 mm Hg for diastolic BP (DBP).
Study Design
Study Design:
Patients Screened: 606
Patients Enrolled: 400
Mean Follow Up: Median 350 days
Mean Patient Age: Mean age 53 years
Female: 52
Patient Populations:
Hypertension, age ≥18 years, untreated or being treated with no more than two different antihypertensive agents, and three consecutive readings of DBP at each of the two run-in visits averaging 95 to 114 mm Hg (patients with higher DBP also qualified, but were re-examined at shorter intervals).
Exclusions:
Heart failure, unstable angina pectoris, stage 3 or 4 hypertensive retinopathy, a history of myocardial infarction or stroke within one year of enrollment, severe noncardiovascular disease (e.g., cancer or liver cirrhosis), serum creatinine concentration higher than 177 µmol/l (2.0 mg/dl), mental disorders, substance abuse, and patients working night shifts
Primary Endpoints:
24-hour ambulatory blood pressure control
Drug/Procedures Used:
Patients were randomized to adjustment of antihypertensive medication based on: 1) self-measured DBP at home (average of six measurements per day during one week; n=203), or 2) physician office-based assessment of BP (average of three sitting DBP readings at the physician's office; n=197). A physician blinded to randomized treatment adjusted antihypertensive medications based on the following targets: DBP above target (>89 mm Hg), antihypertensive treatment intensified; DBP at target (80-89 mm Hg), treatment left unchanged; or DBP below target (<80 mm Hg), treatment reduced.
Principal Findings:
Median follow-up was 350 days. At the end of follow-up, more patients in the home BP group had discontinued antihypertensive drug treatment than in the office BP group (25.6% vs. 11.3%, p<0.001). Frequency of progression to multiple-drug treatment did not differ between home BP or office-based BP (38.7% vs. 45.1%, p=0.14).
BP measurements were higher in the home BP group than office BP group for final office (mean SBP 6.8 and DBP 3.5 difference), home (mean SBP 4.9 and DBP 2.9 difference), and 24-hour ambulatory (mean SBP 4.9 and DBP 2.9 difference) BP measurements (p<0.001 for each). Costs per 100 patients followed for one month were slightly but significantly lower in the home BP group compared with the office BP group ($4,473 vs. $4,921, p=0.04).
Interpretation:
Among patients with hypertension, use of home-based assessment of BP as a guide to initiate and titrate antihypertensive medication was associated with higher rates of antihypertensive drug treatment discontinuation, but higher BPs at follow-up compared with office-based BP assessment. While costs were lower in the home-based BP group, the authors note that an exclusively home-based BP assessment strategy cannot be recommended, given the small but statistically and clinically significant increase in final BPs.
References:
Staessen JA, Den Hond E, Celis H, et al., for the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) Trial Investigators. Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial. JAMA 2004;291:955-64.
Keywords: Eye Abnormalities, Follow-Up Studies, Blood Pressure Determination, Hypertension, Systole
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