Comparative Efficacy of Hypertension Management Strategies

Abstract

Hypertension (HTN) is a major cardiovascular risk factor and a significant contributor to disease burden in the United States. Despite therapeutic advances, gaps remain between clinical trials and practice. This study aims to bridge those gaps by evaluating antihypertensive strategies. This was a retrospective analysis of HTN patients seen at a hospital clinic from 2016 to 2022 with 3- and 12-month follow-up appointments. Demographics, history, blood pressure (BP), and medication regimen were recorded. Treatment strategies were categorized as follows: adding medication (AM), increasing dosage (ID), switching medications (SM), dropped medications (DrM), or no change (NC). Changes in systolic blood pressure (SBP) were compared using linear regressions to assess the efficacy of HTN management. Of 873 patient charts reviewed, 332 patients were included. The AM group had an adjusted ∆SBP of −11 mm Hg at 3 months (p < 0.001) and −9 mm Hg at 12 months (p = 0.006). The ID group had an ∆SBP of −8.5 mm Hg at 3 months (p = 0.074) and −7 mm Hg at 12 months (p = 0.3). ∆SBP between the AM and ID groups was not statistically significant (p = 0.8). SM was associated with an ∆SBP of −3 mm Hg at 3 months (p = 0.6) and −3 mm Hg at 12 months (p = 0.7). There are meaningful differences in SBP reduction between antihypertensive medication adjustment strategies. AM had the greatest effect on lowering SBP, with ID having a slightly lesser effect. The difference in ∆SBP between the AM versus ID groups was not significant. While further study with a larger dataset is warranted, our findings highlight trends in the efficacy of HTN management strategies to help guide therapeutic regimens.

Keywords

hypertension - antihypertensive - strategy - treatment - blood pressure - management - retrospective

Publication History

Article published online:
04 July 2024

• References

• 1 Whelton PK, Carey RM, Aronow WS. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71 (06) 1269-1324 . Erratum in: Hypertension. 2018;71(6):e136-e139. Erratum in: Hypertension. 2018;72(3):e33
• 2 Cushman WC, Whelton PK, Fine LJ. et al; SPRINT Study Research Group. SPRINT trial results: latest news in hypertension management. Hypertension 2016; 67 (02) 263-265
• 3 Willock RJ, Miller JB, Mohyi M, Abuzaanona A, Muminovic M, Levy PD. Therapeutic inertia and treatment intensification. Curr Hypertens Rep 2018; 20 (01) 4
• 4 Aubert CE, Sussman JB, Hofer TP, Cushman WC, Ha JK, Min L. Adding a new medication versus maximizing dose to intensify hypertension treatment in older adults: a retrospective observational study. Ann Intern Med 2021; 174 (12) 1666-1673 Erratum in: Ann Intern Med. 2021 Dec;174(12):1780.
• 5 Mu L, Mukamal KJ. Treatment intensification for hypertension in US ambulatory medical care. J Am Heart Assoc 2016; 5 (10) e004188
• 6 Xu W, Goldberg SI, Shubina M, Turchin A. Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: population based retrospective cohort study. BMJ 2015; 350: h158