Updated meta-analysis for antihypertensive treatment guided by home blood pressure compared to treatment based on office blood pressure: systematic review

Home blood pressure (BP) measurement is widely used, and home BP plays a central role in hypertension management in clinical practice in Japan. We updated the systematic review to determine whether home BP-based antihypertensive treatment is superior to office BP-based treatment in improving clinical outcomes, including BP levels, in adult patients with essential hypertension. A literature search identified 14 randomized controlled trials (RCTs). The results of meta-analysis revealed that home BP-based antihypertensive treatment was significantly associated with greater reductions in ambulatory systolic BP by 2.73 mmHg (95% confidence interval [CI], –5.23 to –2.22 mmHg; p = 0.03) and ambulatory diastolic BP by 1.61 mmHg (95% CI, –3.21 to –0.01 mmHg; p = 0.05) compared to office BP-based treatment. No RCTs evaluating cardiovascular outcomes other than ambulatory BP reduction were identified. Consistent with the previous review, this updated meta-analysis revealed home BP-based antihypertensive treatment is strongly recommended over office BP-based treatment for BP control in patients with essential hypertension.