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. 2010 Jul;3(4):347-57.
doi: 10.1161/CIRCOUTCOMES.110.957308. Epub 2010 May 20.

Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients

Thomas M Maddox  1 , Colleen Ross, Heather M Tavel, Ella E Lyons, Maggie Tillquist, P Michael Ho, John S Rumsfeld, Karen L Margolis, Patrick J O'Connor, Joe V Selby, David J Magid
Affiliations

Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients

Thomas M Maddox et al. Circ Cardiovasc Qual Outcomes. 2010 Jul.

Abstract

Background: Blood pressure (BP) control among coronary artery disease patients remains suboptimal in clinical practice, potentially due to gaps in treatment intensification and medication adherence. However, longitudinal studies evaluating these relationships and outcomes are limited.

Methods and results: We assessed BP trajectories among health maintenance organization patients with hypertension and incident coronary artery disease. BP trajectories were modeled over the year after coronary artery disease diagnosis, stratified by target BP goal. Treatment intensification (increase in BP therapies in the setting of an elevated BP), medication adherence (percentage of days covered with BP therapies), and outcomes (all-cause mortality, myocardial infarction, and revascularization) were evaluated in multivariable models: 9569 patients had a <140/90 mm Hg BP target and 12,861 had a <130/80 mm Hg BP target. Within each group, 4 trajectories were identified: good, borderline, improved, and poor control. After adjustment, increasing BP treatment intensity was significantly associated with better BP trajectories in both groups. Medication adherence had inconsistent effects. There were no significant differences in combined outcomes by BP trajectory, but among the diabetes and renal disease cohort, borderline control patients were less likely to have myocardial infarction (odds ratio, 0.61; 95% confidence interval, 0.40-0.93), and good control patients were less likely to have myocardial infarction (odds ratio, 0.53; 95% confidence interval, 0.34-0.84) or a revascularization procedure (odds ratio, 0.66; 95% confidence interval, 0.47-0.93) compared with poor control patients.

Conclusions: In this health maintenance organization population, treatment intensification but not medication adherence significantly affects BP trajectories in the year after coronary artery disease diagnosis. Better BP trajectories are associated with lower rates of myocardial infarction and revascularization.

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Figures

Figure 1
Figure 1
Cohort Creation
Figure 2
Figure 2
BP trajectories for the no diabetes or chronic kidney disease cohort (n=9519)
Figure 3
Figure 3
BP trajectories for the diabetes and/or chronic kidney disease cohort (n=12861)
Figure 4
Figure 4
Time to first event (all-cause mortality, MI, revascularization) among the no diabetes or chronic kidney disease cohort (n=9562)
Figure 5
Figure 5
Adjusted ORs of combined and individual (all-cause mortality, MI, revascularization) outcomes among the no diabetes or chronic kidney disease cohort (n=9562)
Figure 6
Figure 6
Time to first event (all-cause mortality, MI, revascularization) among the diabetes and/or chronic kidney disease cohort (n=12849)
Figure 7
Figure 7
Adjusted ORs of combined and individual (all-cause mortality, MI, revascularization) outcomes among the diabetes and/or chronic kidney disease cohort (n=12849)
See this image and copyright information in PMC

Comment in

  • Outcomes research: the next generation.
    Kosiborod M. Kosiborod M. Circ Cardiovasc Qual Outcomes. 2010 Jul;3(4):335-6. doi: 10.1161/CIRCOUTCOMES.110.957662. Circ Cardiovasc Qual Outcomes. 2010. PMID: 20647574 No abstract available.

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