Home blood pressure monitoring in antihypertensive treatment for hypertensive patients with anxiety or depression

Background Home blood pressure monitoring（HBPM） has been recommended to evaluate blood pressure,to guide antihypertensive treatment for hypertensive patients and to diagnose white-coat hypertension.However,abnormal BP reading in HBPM could also result in aggravation of emotional disorder in hypertensive patients complicated with anxiety or depression.Objective To study the blood-pressure-lowering effects of HBPM on hypertensive patients with anxiety or depression,and evaluate whether HBPM is applicable to this community.Methods A total of 789 cases of diagnosed hypertensive patients from the same community medical center were selected and surveyed with self-rating anxiety scale（SAS） and self-rating depression scale（SDS）.According to the self-evaluation scores,all subjects were divided into five hypertension groups with slight anxiety,moderate or severe anxiety,slight depression,moderate or severe depression,and no emotional disorder（ED）,respectively.Based on the ways of BP monitoring,all patients in each group were randomized into home blood pressure monitoring group（HBPM-group） and clinic blood pressure monitoring group（CBPM-group）.After 12 weeks of follow-up,the percentages of those who had self-adjusted BP measurement frequency,of those who had self-regulated antihypertensive drugs and of those who had reached target BP in each group were compared.Results In moderate or severe anxiety ED patients of HBPM group,the percentages of patients self-adjustment BP measurement frequency（22,95.7%） and antihypertensive drugs（16,69.6%） were significantly higher than in CBPM group（10,45.4%）,（5,22.7%）,all P＜0.05.At the end of the experiment,the percentage of patients reaching clinic target BP in HBPM-group was lower than in CBPM group（43.5% vs 72.7%,P＜0.05）.In moderate or severe depression ED patients of HBPM group,the percentages of patients self-adjustment BP measurement frequency（14,82.4%） and antihypertensive drugs frequency（10,58.8%） were significantly higher than in CBPM group（2,11.8%）,（3,17.6%）,all P＜0.05.At the end of experimet,the percentages of patients reaching clinic target BP in HBPM-group was lower than in HBPM group（23.5% vs 64.7%,P＜0.05）.In moderate or severe anxiety ED patients of HBPM group,the frequency of self-adjusted of BP measurement（0.77±0.37） and frequency of self-adjusted of antihypertensive drugs（0.14±0.04） were significantly higher than in slight anxiety ED patients of HBPM group（0.09±0.04）（0.08±0.02） and in the patients without ED（0.06±0.03）（0.03±0.02） P＜0.05.In moderate or severe depression ED patients of HBPM group,the frequency of self-adjusted of BP measurement（-0.05±0.34） and frequency of self-adjusted of antihypertensive drugs（-0.15±0.02） were significantly higher than in slight depression ED patients（-0.08±0.10）（-0.09±0.02） and in the patients without ED（0.06±0.03）（0.03±0.02） P＜0.05.Conclusion HBPM is not applicable to hypertension patients with moderate or severe anxiety or depression,because it could make interference in BP monitoring and antihypertensive treatment,and hinder the patients in reaching target BP by their emotional disorders.