SOURCE: Erden S, Mefkure Ozkaya H, Banu Denizeri S, Karabacak E. The effects of home blood pressure monitoring on blood pressure control and treatment planning. Postgrad Med 2016;128:584-590.

Intuitively, incorporation of home blood pressure monitoring (HBPM) into the regimen of BP control interventions should improve outcomes. Encouraging patients to take ownership of their BP management, elimination of white-coat hypertension, and the ability to detect overtreatment by identification of episodes of hypotension at home could improve outcomes of hypertensive patients. But does HBPM improve outcomes?

Erden et al retrospectively evaluated charts of 1,006 hypertensive Turkish adults, of which 40% participated in HBPM. They compared several outcomes: office BP, percent achieving BP control (defined as < 135/85 mmHg), and vascular health (cardiovascular [CV] events and retinopathy).

The HBPM group was statistically significantly more likely to achieve BP control (85% vs. 56%). More difficult to explain is the polarity of vascular results: CV events actually were statistically significantly more common in the HBPM group, whereas retinopathy was less common. While the HBPM group, on average, had been treated for hypertension for a substantially longer duration (nine years vs. seven years), this would not reconcile why one vascular compartment (retina) showed favorable effect, whereas CV events did not, especially since a ponderous amount of clinical trial data shows a consistent relationship between office BP lowering and CV outcomes.