Treatment-resistant hypertension can be monitored using home BP

Home blood pressure monitoring (HBPM) may be a valuable method of monitoring for treatment-resistant hypertension (TRH) and for subsequent risk stratification, a recent study has found.

Moreover, TRH and uncontrolled TRH as diagnosed by HBPM carry higher risks of cardiovascular diseases (CVD) independently of cardiovascular end-organ damage.

The study included 4,261 outpatients (mean age 64.9 years, 46.8 percent men) whose data were retrieved from the nationwide Japan Morning-Surge Home BP study, of whom 91.5 percent were hypertensive. All participants underwent morning and evening HBPM for 14 days and followed for a mean 6.2 years.

Overall, 270 CVDs occurred, including 229 events of atherosclerotic CVDs. TRH, defined as home BP ≥135/85 mm Hg, significantly increased the risk of total CVD events vs non-TRH, even after adjusting for potential confounding factors (adjusted hazard ratio [HR], 1.72, 95 percent confidence interval [CI], 1.27–2.35).

A similar effect was reported when the definition of TRH was changed to home BP ≥130/80 mm Hg (adjusted HR, 1.69, 95 percent CI, 1.30–2.26) and to home BP ≥125/75 mm Hg (adjusted HR, 1.65, 95 percent CI, 1.24–2.20).

“Home BP monitoring is suggested to be useful for risk stratification of patients with TRH. However, further studies are needed to determine whether the management of home BP control in patients with TRH can be useful for prevention of CVD events,” the researchers said.

“To assess this problem in clinical practice, intervention studies will be needed. Moreover, new methods for the management of uncontrolled TRH—including new medications, diet and exercise treatment, or denervation therapy—should be established,” they added.