However, there is conflicting evidence on whether unsupervised home monitoring improves outcomes (Schroeder et al., Reference Schroeder, Fahey and Ebrahim2004) and it is known that in type 2 diabetes it may actually be harmful (Farmer et al., Reference Farmer, Wade, Goyder, Yudkin, French, Craven, Holman, Kinmonth and Neil2007). Self-monitored BP predicts outcome as well as ambulatory measurement (the ‘gold standard’) (Stergiou et al., Reference Stergiou, Mengden, Padfield, Parati and O’Brien2004) and both better than surgery-based measurements. Despite this, BP control in practice remains inadequate, with slow responses to high surgery-based measurements (Primatesta and Poulter, Reference Primatesta and Poulter2004). The time taken to achieve control also has a significant impact on event rates (Julius et al., Reference Julius, Kjeldsen, Weber, Brunner, Ekman, Hansson, Hua, Laragh, McInness and Mitchell2004). Intervention trials show that every 10 mmHg fall in systolic blood pressure (BP) is associated with reduction in risk of stroke and coronary events of 40% and 20%, respectively (Poulter et al., Reference Poulter, Wedel, Dahlof, Sever, Beevers, Caulfiel, Kjeldsen, Kristinsson and McInnes2005).
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