The APTH (Ambulatory Blood Pressure and Treatment of Hypertension) trial in 1997, the THOP (Treatment of Hypertension Based on Home or Office Blood Pressure) trial in 2004, and the HOMERUS (Home versus Office MEasurements, Reduction of Unnecessary treatment Study) trial in 2007 failed to show any significant difference in surrogate endpoint outcomes, such as left ventricular mass changes, with a slight trend toward lower medication costs balanced by the higher costs of the ambulatory and home blood pressure equipment. 43 - 45 Moreover, the idea of developing an ideal trial for absolute evidence becomes a difficult task, as noted by the Agency for Healthcare Research and Quality (AHRQ), which has estimated that a sample size of 26 000 to 57 000 patients would be needed to achieve a 10% relative risk reduction in a 10-year trial comparing office versus ambulatory blood pressure monitoring. 46 Such a trial is unlikely to happen anytime soon.
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