Engaging men in health

March 2009

Research

A cardiovascular risk clinic using home BP monitoring

Volume 38, No.3, March 2009 Pages 163-166

Patrick D Byrnes

Geoffrey K Mitchell

Margaret Crawford

Colleen McGoldrick

Background

Hypertension is the most common chronic condition managed in general practice, but blood pressure (BP) control is often suboptimal. Home blood pressure (HBP) monitoring can be more accurate than office based BP (OBP) monitoring, with HBP readings ~10/5 mmHg lower than OBP in the same patients.

Methods

Hypertensive patients from a single general practice were invited to a cardiovascular risk review clinic using HBP monitoring. Outcome measures were BP reading, BP meeting adjusted target of 120/80 if aged <65 years or 130/85 if aged >65 years, owning home BP monitor, numbers enrolling and numbers attending 12 month follow up.

Results

Of 524 eligible patients, 414 (79%) enrolled in the clinic, of whom 89% completed the trial. At 12 months, HBP control rates rose from 29.9% to 44.8%, with mean HBP falling 5.2/3.2 mmHg (p<0.001). Home BP monitor ownership rose from 54.3 to 82.9%.

Discussion

This is the first study in standard Australian general practice using both a comprehensive clinic approach and HBP readings exclusively. This study provided a feasible management protocol and practical clinical performance indicators that could be used for a randomised controlled trial. Significantly better control rates were achieved compared with published studies for BP control.

Hypertension is the most common chronic condition managed in general practice, comprising 6.3% of all consultations and 18.1% of all chronic disease consultations.1 Blood pressure (BP) reduction to recommended levels reduces stroke risk by 40%,2 and in isolated systolic hypertension any cardiovascular event by 25%.3 Above 115 mmHg, systolic reductions as little as 2 mmHg decrease the relative risk from stroke mortality by up to 10% and ischaemic heart mortality by 7%.4

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Correspondence afp@racgp.org.au

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