In a study entitled “Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: population based retrospective cohort study,” published in the British Medical Journal (BMJ), a research team from Brigham and Women’s Hospital (BWH) identified important factors to minimize the risks of hypertension through treatment improvement.
Hypertension or high blood pressure is the most common risk factor for heart disease and stroke, making it one of the most important causes of premature death worldwide.
There is little data relating to a rise in blood pressure levels and increase of medication dosage or introduction of new medication (medication intensification). In fact, it is unclear whether medical treatment of patients with systolic hypertension of 140-159 mm Hg reduces the risk of cardiovascular events or death. The medical guidelines to treat these patients differ considerably between institutions based on age, cardiovascular risk factors, pre-existing diabetes or end organ damage.
This retrospective cohort study investigated the systolic intensification threshold, time to intensification, and time to follow-up that is associated with the lowest risk of cardiovascular events or death. A total of 88,756 adult patients suffering with hypertension were identified from The Health Improvement Network database between 1986 and 2010 with a mean follow-up time of 37.4 months after treatment strategy. From these, 9,985 (11.3%) patients had an acute cardiovascular event or died.
The authors concluded that the time to medication intensification and the time to follow-up after intensification are independent predictors of the risk of cardiovascular morbidity or death. The data obtained showed that systolic intensification thresholds higher than 150 mm Hg increased the risk of an acute cardiovascular event or death. In addition, delays greater than 1.4 months before medication intensification after systolic blood pressure elevation above 150, and delays greater than 2.7 months before blood pressure follow-up after medication were also associated with a negative outcome. However, the majority of patients in the study did receive follow-up assessments within this window of time.
“Hypertension is treatable — the right medical treatment can mitigate a person’s risk. But we need to know the optimal blood pressure, the optimal time to intensify treatment and the optimal time to reassess,” senior author Alexander Turchin, MD, MS, a physician and researcher in the Division of Endocrinology at BWH, said in a news release. “Our research supports the importance of avoiding delays in treatment and having follow-up appointments for patients with hypertension.”