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Copyright 2001, HOMED-BP Secretariat All Right Reserved. Hand-o ut infor mation Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure Study General background and design The HOMED-BP explored to what extent long-term antihypertensive treatment guided by the home BP impacted on cardiovascular outcomes in patients. aged ≥40 years were recruited from 457 general practices throughout Japan. HOMED-BP is a clinical trial with prospective randomized open-blinded endpoint evaluation (PROBE) design. Patients with home BP ≥135/85 mm Hg (home BP <180/120 mm Hg and clinic BP <220/125 mm Hg) Treatment naïve patients as well as previously treated patients, whose antihypertensive drug treatment could be discontinued for ≥2 weeks, qualified for enrolment. Measurement and treatment after randomization Based on the 2 × 3 factorial design, 3518 eligible patients were randomized to usual (125–134/80–84 mm Hg [UC]) vs. tight (<125/<80 mm Hg [TC]) control of home BP and to initiation of drug treatment with CCB, ACEI or ARB. These randomizations, performed by the host computer, are transmitted to terminal microcomputer at outpatient clinical via the Internet. Home BP is measured using OMRON HEM 747IC-N (Omron Healthcare Co.,Ltd, Kyoto, Japan) with IC memory, which can store up to 350 readings in its memory. Practitioners obtained 2 consecutive clinic BP using the fully automated oscillometric OMRON HEM-907IT (Omron Healthcare). At each outpatient visit, the home BP values stored in memory were uploaded to the server. These values were automatically calculated by the server and immediately displayed on the screen of the local computer in the practices along with an advice for treatment adStep 1: CCB, ACEI or ARB justment based on a computerized algorithm running Step 2: Dose increment on the central server. Treatment Step The algorithm consisted of 5 steps (right panel). When the home BP was less than 110 mm Hg systolic or 65 mm Hg diastolic, treatment was tailored down. Step 3: Addition of diuretics Step 4: Addition of α or β blockers Step 5: Use of any drugs Main results and interpretation At last follow-up (median 5.3 years), 1759 TC compared with 1759 UC patients used more antihypertensive drugs (1.82 vs. 1.74 defined daily doses, p=0.045), had more home BP reduction (21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg, p=0.018/0.020), but less frequently achieved the lower home BP targets (37.4% vs. 63.5%, p<0.0001). The primary endpoint, cardiovascular death plus stroke and myocardial infarction, occurred in 25 UC and 26 TC patients (p=0.94). Rates were also similar (p≥0.13) in the 3 drug groups. In all patients combined, the risk of the primary endpoint independently increased by 41% (p=0.019) and 47% (p=0.0020) for a 1-SD increase in baseline (12.5 mm Hg) and follow-up (13.2 mm Hg) systolic home BP. The 5 year risk was minimal (≤1%) if on-treatment systolic home BP was 131.6 mm Hg or less. Acknowledgements HOMED-BP study, endorsed by the Japanese Society of Hypertension, is supported by grants from the Japan Cardiovascular Research Foundation and the Japan Arteriosclerosis Prevention Fund. HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on home BP. The study suggests that a systolic home BP level of 130 mm Hg should be an achievable and safe target. Fujitsu Systems East Limited (Sendai, Japan) and Omron Healthcare Co. (Kyoto, Japan) have developed and maintained the Internet and home BP based systems. The HOMED-BP study is designed, conducted, and interpreted by the investigators independently of all sponsors and companies. Contact: Kei Asayama MD, PhD Studies Coodinating Centre, KU Leuven e-mail: [email protected] Recent publications 1. Y Noguchi et al. Predictive power of home blood pressure and clinic blood pressure in hypertensive patients with impaired glucose metabolism and diabetes. J Hypertens. 2013: 1593. 2. K Kamide et al. Genome-wide response to antihypertensive medication using home blood pressure measurements —a pilot study nested within the HOMED-BP study. Pharmacogenomics 2013 (in press) 3. K Asayama et al. Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure. Hypertens Res. 2012: 1102.
