[The role of home pressure monitoring in the treatment hypertension in the practice of general medicine]. / Prínos domácího merení tlaku k lécbe hypertenze v praxi vseobecných lékaru.

AIM OF THE STUDY: The aim of the study was to evaluate home blood pressure (BP) measurement using an OMRON HEM 706 device (including printout values) for the treatment of essential hypertension by a greater number of general practitioners and to establish the incidence of "white coat hypertension". METHODS: We compared home BP values, taken by the portable digital Omron HEM 706 device with casual BP values, measured during the course of a 6-month treatment of essential hypertension by the ACE inhibitor perindopril or a combination of perindopril and a diuretic (most frequently a low dose of hydrochlorothiazide) in 503 patients with mild to moderate essential hypertension. Czech and Slovak general practitioners participated in the study. Home BP measurement was performed by the patients always during the 4 days preceding the visit by the general practitioner. Home BP was measured twice daily, "trough" and "peak" values (in the morning before the use of drug and then between noon and 2.00 p.m.), each time twice. The OMRON device enables to print out the measured values. Casual hypertension was defined as casual BP 140/90 mmHg and higher, "home hypertension" was defined as a mean BP higher than 130/85 mm Hg from 8 home BP measurements performed during the last 2 days before the visit by the general practitioner higher than 130/85 mmHg. RESULTS: A significant decrease in both systolic and diastolic BP occurred during the treatment by perindopril or the combination of perindopril and a diuretic. The decrease in BP was observed both in the casual BP values and in the home BP values. Normalisation of the casual diastolic BP (diastolic BP lower than 90 mmHg) occurred in 59.3% of the patients after the first month of treatment, in 75.4% of the patients after 3 months of treatment, and in 78.5% of patients after 6 months of treatment. Only 2.1% of patients dropped out from the study due to side effects. These data demonstrated a very good efficacy and tolerance of perindopril. Only 62.6% of general practitioners showing interest in home BP measurement at the informative meetings joined the study and 14-19% of patients of the whole studied group did not use home BP at all. In general the interest of general practitioners and their patients observed in this study was less than that observed among the cardiologists in our previous study. The incidence of the "white coat phenomenon" was related to its definition, it increased when using a less strict definition and decreased during the course of therapy, in parallel to the normalisation of BP. Home BP values were significantly higher during the first 2 day of measurement then during the last 2 days of measurement (of the 4-days period). "White coat hypertension" could be observed in 9.4% of the group during the study. Home BP measurement also enabled to disclose "white coat normotension" defined as normal casual BP values and hypertensive home BP values. "White coat normotension" occurred at the end of the study in 26.3% of the patients. This relatively high number of patients with "white coat normotension" could be partly due to a short period of rest at home before taking home BP values. CONCLUSION: Home BP measurement was positively evaluated both by the general practitioners and patients. Home BP measurement provides better information about the efficacy of hypertension treatment and discloses "overtreatment" ("white coat hypertension") as well "undertreatment" ("white coat normotension"). It also increases the adherence of patients to the treatment of essential hypertension. The interest in home BP measuring was, however, less among the general practitioners and their patients than among the cardiologists and their patients (observed in a previous study).