Link → Intensifying Therapy for Hypertension Despite Suboptimal Adherence -- Rose et al., 10.1161/HYPERTENSIONAHA.109.133389 -- Hypertension
Abstract—More intensive management can improve controlblood pressure (BP) in hypertensive patients. However, manywould posit that treatment intensification (TI) is not beneficialin the face of suboptimal adherence. We investigated whetherthe effect of TI on BP varies by adherence. We enrolled 819patients with hypertension, managed in primary care at an academically-affiliatedinner-city hospital. We used the following formula to characterizeTI: (visits with a medication change-visits with elevated BP)/totalvisits. Adherence was characterized using electronic monitoringdevices (“MEMS caps”). Patients who returned their MEMS caps(671) were divided into quartiles of adherence, whereas patientswho did not return their MEMS caps (148) had “missing” adherence.We examined the relationship between TI and the final systolicblood pressure (SBP), controlling for patient-level covariates.In the entire sample, each additional therapy increase per 10visits predicted a 2.0 mm Hg decrease in final SBP (P<0.001).After stratifying by adherence, in the “best” adherence quartileeach therapy increase predicted a 2.1-mm Hg decrease in finalSBP, followed by 1.8 for the “next-best” adherence quartile,2.3 in the third quartile, and 2.4 in the “worst” adherencequartile. The effect size for patients with “missing” adherencewas 1.6 mm Hg. The differences between the group with “best”adherence and the other 4 groups were not statistically significant.In this observational study, treatment intensification was associatedwith similar BP improvement regardless of the patient’s levelof adherence. A randomized trial could further examine optimalmanagement of patients with suboptimal adherence.
