Patrick D Byrnes
Geoffrey K Mitchell
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.
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.
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%.
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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