Can a daytime profile of home blood pressure monitoring prevent hypotension due to overdosing or interaction with other drugs?

Objective: Hypotension occurs during treatment for hypertension relatively rarely, but the new BP thresholds and targets support its more frequent occurrence. It concerns mainly the time of peak effect of antihypertensive and all the medication reducing BP, respectively. Office BP measurements are falsely higher. HBPM is more objective, especially when HBP telemonitoring (HBPTM) and checking of the rest before BPM is used. Design and method: Personal BP monitors wirelessly connected to mobile phones for data transfer were used. The required 5 minutes of physical inactivity before BPM were checked in by smart wristbands. 112 predominantly treated patients with essential hypertension aged 24-85 years, 61% males, were referred as well controlled. A daytime profile of HBPM (triplets of BPM each hour during one daytime) was a part of the study comparing HBPTM and ABPM. Medication was taken immediately after the first morning BPM. Based on several cases of hypotension in patients treated with perindopril/indapamide/amlodipine and perindopril/indapamide reported to a hypertension consultation website, the time of the peak effect 5 hours was chosen. Results: The average systolic BP (SBP) was 132.2 mmHg before taking medication and 126.5 mmHg after 5 hours (n=95). Decrease of SBP in mmHg (difference between the starting level and that after 5 hours) was preliminary analyzed by paired t-test: 0.92+12.78, p=0.799, (untreated, n=13); 2.18+10.8, p=0.248 (1 drug, n=34), 8.04+12.28, p= 0.002, (2 drugs, n=28), 12.15+18.87, p=0.031 (3-5 drugs, n=13). One patient with SBP value even below 100 mmHg, did not report spontaneously any symptoms of hypotension. Conclusions: Decrease of SBP was statistically significant after 5 hours from drug taking in groups treated with 2 and more antihypertensive drugs. Though we did not find any problems associated with hypotension, it is necessary to be careful especially in patients with sedentary occupation whose working activity can be at least suppressed. Under the unfavorable constellation of other BP decreasing factors hypotension can cause a fall due to vertigo or even car accident. Therefore, HBPM with a daytime profile seems to be a suitable tool to identify hypotension.