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Objective: Home blood pressure (BP) monitoring is one of the tools recommended in hypertension management. However, its influence in older adults is seldom investigated. We aimed to assess whether regular home BP monitoring leads to a reduction of BP and an improvement in hypertension control in older adults., Methods: In a 24-month trial, individuals aged 73-97 years were randomized in a control (office and home BP measured at 0, 12, and 24 months) or an intervention (office measured at 0, 12, and 24 months; home BP measured every 3 months) group. The primary outcome was the difference in means office BP over 24 months in hypertensive patients. Secondary outcomes included differences in mean home BP over follow-up in hypertensive patients, and frequency of hypertension and of drug use at 24 months in the total sample. Intention-to-treat analyses comprised 1733 persons, among which 1043 were hypertensive., Results: Hypertensive patients in the intervention group experienced a significantly greater fall in office systolic BP (SBP) [mean between-group difference -2.1 mmHg, 95% confidence interval (CI) -4.1; -0.2, P = 0.03], home SBP (mean between-group difference -3.4, 95% CI -4.8; -2.1, P < 0.0001), and home diastolic BP (mean between-group difference -1.1, 95% CI -1.8; -0.4, P = 0.002) than those in the control group, in the main model. No overall differences were observed for office diastolic BP (P = 0.74), frequency of hypertension (P = 0.92), or drug use (P = 0.51) over time. Similar results were observed after adjustment for known predictors of BP though attenuated for office SBP (P = 0.07)., Conclusion: Regular home BP monitoring every 3 months without co-intervention results in small but greater reductions of BP over time. Further research in large trials focused on older adults is needed to confirm the effectiveness of this intervention in a variety of settings.

Objective: To assess the 1-year risk of developing sustained hypertension in untreated elderly with white-coat hypertension (WCHT) or masked hypertension (MHT), and the 1-year risk of developing uncontrolled hypertension in treated elderly with office or home uncontrolled hypertension (OUHT or HUHT)., Methods: We studied the 1-year risk of developing sustained or uncontrolled hypertension in a community-based cohort of 1481 individuals aged at least 73 years. The same BP device was used throughout the entire study. WCHT was defined as high blood pressure (BP) at office and normal home BP without antihypertensive intake, OUHT as high office BP and normal home BP with antihypertensive intake, MHT as high BP at home and normal office BP without antihypertensive intake, and HUHT as high home BP and normal office BP with antihypertensive intake. Sustained hypertension was defined as high office and home BP without antihypertensive intake and uncontrolled hypertension as high office and home BP with antihypertensive intake., Results: Sustained or uncontrolled hypertension at 1 year was diagnosed in 13% of participants with high office BP and in 26% of those with high home BP. Compared to participants with normal office and home BP, risk of sustained/uncontrolled hypertension was increased about three-fold in individuals with high office BP [OR = 2.9; 95% confidence interval (CI) = 1.5-5.5; P = 0.002] and about seven-fold in those with high home BP (OR = 6.8; 95% CI = 3.8-12.2; P < 0.0001). These risks were higher in individuals not treated by antihypertensive (OR(WCHT) = 4.3, P = 0.03; OR(MHT) = 16.8, P < 0.0001)., Conclusion: In this community-based study, elderly individuals with high office or home BP had an increased risk of hypertension 1 year later. This risk was higher among individuals not treated by antihypertensive and particularly in those with MHT. As these high-risk individuals would be otherwise undetected our results strongly support the large use of home blood pressure measurement in the elderly.