Best Times to Intervene in Hypertension Treatment

New research published in the British Medical Journal has answered some of the most basic questions about treating hypertension.

Researchers from Brigham and Women’s Hospital were tasked with finding optimal times to add new antihypertensive medications or increase doses of existing ones. They also wanted to examine the relationship between delays in medication intensification and the follow-up and risk of death or cardiovascular events, defined as myocardial infarction, cerebrovascular accident, acute congestive heart failure episode, or peripheral vascular disease.

More than 88,000 adults with hypertension were examined in the study. The researchers took a look at the rates of cardiovascular events and all-cause death among patients using different hypertension treatment strategies. More specifically, they examined the systolic intensification threshold, time to intensification, and time to follow-up over the course of a 10-year treatment period.

Around the 37-month mark, 11.3% of participants had died or experienced a cardiovascular event.

The researchers also determined that:

· Patients with systolic intensification thresholds of >150 mm Hg saw progressively higher risk. However, there was no difference in risk for patients with thresholds of 130 to 150 mm Hg.

· Delaying intensification of treatment by more than 1.4 months also increased risk.

· Patients who did not receive a reassessment of blood pressure levels within 2.7 months were at increased risk of death.

Although the latest Joint National Committee (JNC 8) hypertension guidelines do not provide an interval for blood pressure assessment, they do recommend intensifying treatment within a month if the targeted blood pressure is not acquired on the patient’s current treatment.

Study author Alexander Turchin, MD, MS, director of informatics research and associate professor at Harvard Medical School, told Pharmacy Times that these findings will have a direct impact on pharmacists.

“As health care delivery models are changing, pharmacists are beginning to play an increasingly active role in management of chronic diseases like hypertension,” Dr. Turchin told Pharmacy Times.

Patient care has never seemed unidimensional to Dr. Turchin, who became interested in the subject of hypertension treatment after realizing that the timing of medications in this particular area had not been examined before.

However, Dr. Turchin noted that the results of the study may seem intuitive to pharmacists.

“Any kind of increase in pressure in the system damages the system’s components, and it will not be surprising to anyone that increasing the time over which a human body is exposed to high blood pressure will negatively impact that individual’s health,” Dr. Turchin told Pharmacy Times.

Nevertheless, hypertension research will become more and more relevant to pharmacists as they help manage the condition, Dr. Turchin said.

“Particularly at this time of shortage of primary care physicians who may not have room in their schedule for a more intensive treatment strategy, pharmacists have an opportunity to step up to provide timely treatment intensification and follow-up to patients with high blood pressure,” Dr. Turchin said.