Intensive antihypertensive treatment (≤130 mm Hg) was favored by doctors overall (OR 2.70; 95% CI 1.84-9.96), though preference decreased with patient age, recent falls, and moderate frailty.
Cross-Sectional
What patient attributes influence doctors' preferences for intensive versus standard antihypertensive treatment in older adults?
Doctors' decisions to intensify antihypertensive treatment in older adults are significantly influenced by patient age, frailty, fall history, and access to digital monitoring data.
Effect estimate: OR 2.70 (95% CI 1.84-9.96)
BACKGROUND Understanding which attributes influence blood pressure (BP) prescribing, and the magnitude of their effects, could inform strategies to reduce clinical inertia in older adults. OBJECTIVES The purpose of this study was to examine doctors' preferences and trade-offs when deciding to intensify antihypertensive treatment in adults aged ≥65 years with uncontrolled BP. METHODS We conducted a discrete choice experiment with Australian doctors, presenting hypothetical patient profiles varying by age, frailty, fall history, residual cardiovascular risk, and availability of digital health monitoring. Doctors chose between 2 systolic BP targets: intensive (≤130 mm Hg) or standard (131-150 mm Hg). A mixed multinomial logit model was used to estimate attribute effects, and latent class analysis to explore heterogeneity in preferences. RESULTS Overall, doctors favored the intensive treatment target (OR: 2.70; 95% CI: 1.84-9.96) but this preference decreased with increasing patient age (eg, age 80; OR: 0.05; 95% CI: 0.03-0.07), recent falls (OR: 0.22; 95% CI: 0.16-0.29), and moderate frailty (OR: 0.24; 95% CI: 0.12-0.46). Higher residual cardiovascular risk reduced the likelihood of intensive treatment, whereas digital health availability increased it (OR: 1.50; 95% CI: 1.05-2.15). Latent class analysis identified 2 groups: risk tolerant, digitally engaged (64%), who preferred intensive treatment and were responsive to digital data, and risk-averse (36%), with no overall preference and were unaffected by digital information. CONCLUSIONS Clinicians' decisions to intensify antihypertensive treatment in older adults are influenced by age, falls, frailty, perceived benefit, and access to digital monitoring data. Use of digital health interventions may reduce clinical inertia and should be evaluated in clinical trials.
O’Hagan et al. (Sun,) conducted a cross-sectional in Uncontrolled blood pressure. Intensive systolic BP target (≤130 mm Hg) vs. Standard systolic BP target (131-150 mm Hg) was evaluated on Preference for intensive treatment target (OR 2.70, 95% CI 1.84-9.96). Intensive antihypertensive treatment (≤130 mm Hg) was favored by doctors overall (OR 2.70; 95% CI 1.84-9.96), though preference decreased with patient age, recent falls, and moderate frailty.