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Gerin W, Pickering T, Holland J, Alter R,
Glenn J.
Circulation1998(S1). 97:17, 1695.
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Abstract: Hypertension (HT) is
typically diagnosed using blood pressure (BP) measurements
taken in a doctor's office. However, these may be unreliable,
and studies show that 20-30% of mild HT patients have
high BP only in the doctor's office (white coat HT), which
may lead to unnecessary use of BP medication. Thus, office
visits to check BP may not be a cost-efficient, reliable
means of HT management. Studies show that home BP is a
useful alternative to office BPs; however, compliance
has been poor. We used a home BP monitor with a built-in
modem that allows patients to transmit BPs to their doctors
without a computer. Fifty patients (31 F, 19 M) participated
in a home-monitoring study. All had office BP>140/90,
most taking BP medication. All underwent ambulatory BP
monitoring (ABP) at the start of the 2-month study. Subjects
were asked to take 2-3 readings at a time, twice a day,
2 days per week; and to transmit these at pre-determined
intervals. Telephone follow-up was used to enhance compliance,
when transmissions were late. Of the 50 subjects, 10 (20.0%)
had mean home BP < 135/85, indicating that medication
could be reduced or withdrawn. Agreement in diagnosis
between home and ABP was 90%. Unlike previous studies,
compliance was very high: 40 subjects (80.0%) sent an
average of 6 or more BPs per week; an additional 9 (18.0%)
sent an average of 2-5/week. This represents a significant
improvement in compliance over trials in which modem transmissions
were not used (c2=23.09, p< .001) . We suggest that
home monitoring is a useful alternative to office visits
for management of HT, and that the ability to transmit
BP by telephone maintains good compliance and reduces
maintenance visits and costs. Finally, home monitoring
appears to be a useful means of identifying white coat
HT, which may allow reduction of medication for some patients
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