Short Follow-Up Intervals For Hypertension Reduces Adverse Events

dr-alexander-turchinMedicalResearch.com Interview with:
Dr. Alexander Turchin M.D.,M.S.
Director of Informatics Research
Division of Endocrinology, Brigham and Women’s Hospital
Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Turchin: Hypertension is the most common risk factor for cardiovascular events. High blood pressure increases the risk for stroke, myocardial infarction, heart failure and kidney failure. Treatment of high blood pressure reduces these risks. However, our understanding of optimal treatment of hypertension is incomplete. In particular, there is little information to guide clinicians on how quickly they should achieve blood pressure control in their patients. There have been no clinical trials focusing on this question. Current guidelines are sparse and are based only on expert opinion.

Our study analyzed treatment of nearly 90,000 patients in primary care practices in the U.K. between 1986 and 2010. We found that patients whose blood pressure medications were adjusted within 1.4 months after systolic blood pressure reached over 150 mm Hg and whose blood pressure was re-assessed within 2.7 months after their treatment was adjusted had the lowest risk for acute cardiovascular events and death from any cause.

Medical Research: What should clinicians and patients take away from your report?

Dr. Turchin: Our main finding is that time is money in treatment of high blood pressure. Both treatment adjustments after patient is found to have an elevated blood pressure and re-assessment of the effect of treatment change have to be done in a timely fashion to optimize long-term patient outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Turchin: Our study was a retrospective / database analysis. Future studies should include an interventional clinical trial that would compare different strategies in treatment of high blood pressure to confirm the optimal time frame for therapy of hypertension. We also need studies that would focus on particularly vulnerable patients, such as individuals with diabetes mellitus, kidney disease, heart disease and older patients, to determine whether optimal treatment parameters are the same or different for them.

Citation:

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 doi: http://dx.doi.org/10.1136/bmj.h158 (Published 05 February 2015)  BMJ 2015;350:h158

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