Benefit of home blood pressure measurement after a finding of high blood pressure at a community screening

Objective Many hypertensive individuals are not under medical management. We studied whether incorporating home blood pressure measurement and subsequent tailored advice into the primary care system improved hypertension management among untreated hypertensive individuals (screening systolic blood pressure >= 140 mmHg or diastolic blood pressure (>=) 90 mmHg and not taking antihypertensive medication) diagnosed during a community screening. Methods All residents aged 30 years or older in one district were asked to measure their blood pressure at home for 30 days, then received tailored advice (intervention area). Four of five Japanese districts served as a control. A self-administered questionnaire monitored the awareness and treatment of hypertension. Results Eighty-eight per cent (106/120) of untreated hypertensive individuals in the intervention area measured home blood pressure. Of men and women meeting the criteria for untreated hypertension at a community screening in 2003, 97 intervention and 390 control individuals were rescreened in 2004. Among the untreated 2003 screening hypertensive individuals with home hypertension (home systolic blood pressure >= 135 mmHg or diastolic blood pressure >= 85 mmHg), the proportion not starting antihypertensive medication was 56%, and the proportion taking 'no action against hypertension' was 41%. These proportions were lower than in the control group (76%, 60%), yielding odds ratios (95% confidence interval) of 0.38 (0.21-0.68) and 0.42 (0.24-0.75), respectively. Conclusion Incorporating home blood pressure measurement coupled with tailored advice into the primary care system has the potential to reduce the risk of untreated hypertension.