Blood pressure control in patients initiating antihypertensive therapy

Abstract

Background: Although information concerning the attainment of goal blood pressure for patients commencing antihypertensive therapy is available from controlled trials, no studies have examined this issue in the context of typical clinical practice.

Objective: To examine attainment of blood pressure control over time in patients initiating antihypertensive therapy in clinical practice.

Methods: Using an electronic medical records database, we identified all adults with systolic blood pressure (SBP)/diastolic blood pressure (DBP) of 140/90 mm Hg or higher who initiated antihypertensive drug therapy. Subjects were stratified into subgroups based on the presence of high-risk conditions or characteristics described by the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in their seventh report as "compelling indications" (eg, diabetes) or "special situations" (eg, obesity). Blood pressure control was examined in terms of goal attainment and reductions in blood pressure using last available readings at days 90, 180, and 360, following therapy initiation.

Results: Among the 10,345 study subjects, 47% had compelling indications and 39% had special situations. In the former group, 62% (95% CI 61 to 64) of patients with Stage 1 hypertension (140-159/90-99 mm Hg) attained blood pressure less than 140/90 mm Hg by day 360; among those with Stage 2 hypertension (> or =160/100 mm Hg), the corresponding figure was 48% (95% CI 46 to 50). In the latter group, 64% (95% CI 61 to 66) and 55% (95% CI 53 to 57) of patients with Stage 1 and Stage 2 hypertension, respectively, attained blood pressure less than 140/90 mm Hg by day 360. Among those without high-risk conditions, these percentages were 63% (95% CI 59 to 67) and 55% (95% CI 52 to 59). Among patients with diabetes or chronic kidney disease, 25% (95% CI 24 to 26) attained blood pressure less than 130/80 mm Hg by day 360.

Conclusions: Many patients starting antihypertensive therapy in clinical practice fail to achieve blood pressure control within the first year. Control is no better, and perhaps worse, among patients at highest risk of adverse outcomes.