Intensive blood pressure treatment required adding a mean of 0.6 medications to initial regimens over 18 months, compared to a mean reduction of 0.1 medications in the standard arm.
RCT
Randomized
Does intensive blood pressure treatment increase antihypertensive medication complexity compared to standard treatment in SPRINT participants?
Intensive blood pressure treatment requires greater medication complexity, with patients adding an average of 0.6 medications over 18 months compared to standard treatment.
Absolute Event Rate: 0.6% vs -0.1%
Background: Details of antihypertensive medication regimens used to achieve intensive systolic blood pressure (SBP) goals have not been described. Objective: Determine the distribution and longitudinal changes in antihypertensive medication regimens in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: We used antihypertensive medication data collected by pill bottle review at each visit to categorize antihypertensive regimens by medication class. Free text string variables of medication names were independently reviewed by two clinical pharmacists to create standardized generic medication names and classes. Results: Figure 1 illustrates longitudinal changes in class combinations and number of drugs at the randomization, 6, 12, and 18-month visits. Fifty-six percent of participants modified their initial regimen by the 6-month visits; 43% of participants made additional modifications to their regimens from the 6-month to the 18-month visit. The most common initial regimens, and least likely regimens to be changed over time, were combinations with an ACEI/ARB and diuretics ± other classes (42% of initial regimens). Participants in the intensive arm added a mean (standard deviation) of 0.6 (0.9) medications to their initial regimens in the first 18-months compared to -0.1 (0.9) in the standard arm. Conclusion: Intensive blood pressure treatment requires more medication complexity in terms of class and dose. Further study of distinct regimens may reveal if certain class and dose combinations provide better SBP control, safety, or patient satisfaction.
King et al. (Sat,) conducted a rct in Hypertension. Intensive blood pressure treatment vs. Standard blood pressure treatment was evaluated on Number of medications added to initial regimens in the first 18 months. Intensive blood pressure treatment required adding a mean of 0.6 medications to initial regimens over 18 months, compared to a mean reduction of 0.1 medications in the standard arm.
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