Document Detail

Intensifying therapy for hypertension despite suboptimal adherence.
MedLine Citation:
PMID:  19581506     Owner:  NLM     Status:  MEDLINE    
More intensive management can improve control blood pressure (BP) in hypertensive patients. However, many would posit that treatment intensification (TI) is not beneficial in the face of suboptimal adherence. We investigated whether the effect of TI on BP varies by adherence. We enrolled 819 patients with hypertension, managed in primary care at an academically-affiliated inner-city hospital. We used the following formula to characterize TI: (visits with a medication change-visits with elevated BP)/total visits. Adherence was characterized using electronic monitoring devices ("MEMS caps"). Patients who returned their MEMS caps (671) were divided into quartiles of adherence, whereas patients who did not return their MEMS caps (148) had "missing" adherence. We examined the relationship between TI and the final systolic blood pressure (SBP), controlling for patient-level covariates. In the entire sample, each additional therapy increase per 10 visits predicted a 2.0 mm Hg decrease in final SBP (P<0.001). After stratifying by adherence, in the "best" adherence quartile each therapy increase predicted a 2.1-mm Hg decrease in final SBP, followed by 1.8 for the "next-best" adherence quartile, 2.3 in the third quartile, and 2.4 in the "worst" adherence quartile. The effect size for patients with "missing" adherence was 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 associated with similar BP improvement regardless of the patient's level of adherence. A randomized trial could further examine optimal management of patients with suboptimal adherence.
Adam J Rose; Dan R Berlowitz; Meredith Manze; Michelle B Orner; Nancy R Kressin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2009-07-06
Journal Detail:
Title:  Hypertension     Volume:  54     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-20     Completed Date:  2009-09-18     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  524-9     Citation Subset:  IM    
Center for Health Quality, Outcomes, and Economic Research, Boston University School of Medicine, 200 Springs Road, Bedford, MA 01730, USA.
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MeSH Terms
Antihypertensive Agents / classification,  therapeutic use*
Blood Pressure / drug effects*,  physiology
Hypertension / drug therapy*,  physiopathology
Medical Records Systems, Computerized / statistics & numerical data
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care) / methods,  statistics & numerical data
Patient Compliance / statistics & numerical data*
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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