Home blood pressure monitoring: its effect on the management of hypertension in general practice.

BACKGROUND Ambulatory and home blood pressure monitoring have been shown to improve the management of hypertension. Either can be used to diagnose 'white coat hypertension' (WCH), which affects 10% to 20% of hypertensives and usually does not require drug treatment. Home monitoring has been used little in primary care. AIM To investigate the use and acceptability of home monitoring, and to establish the incidence of WCH as diagnosed in a primary care setting. METHOD Twenty practices were asked to monitor hypertensive patients, in particular those about to start drug treatment and those who were poorly controlled. RESULTS A total of 660 patients were monitored. Sixty-four (27%) of the 236 untreated patients had WCH and no medication was started in 60 (94%) of this group. Forty-five (17%) of the 258 poorly-controlled patients had WCH and, of these, 34 (76%) continued with the same medication and 11 (24%) either reduced or stopped it. Compliance with recording was high. Questionnaires and focus groups with doctors and nurses showed that home monitoring represented a valuable enhancement of their management of hypertensive patients. Patients reported a high degree of interest and satisfaction with monitoring. CONCLUSIONS Patients, doctors, and nurses found monitoring valuable, and found the instruments easy to use with few problems. The feasibility of screening for WCH with home blood pressure monitoring was demonstrated, and, for this specific purpose, it is recommended as the preferred alternative to ambulatory monitoring in primary care.