Key result
Updated hypertension guidelines fail to improve one-year blood pressure control among US Veterans.
Why the study?
Amid persistently low blood pressure control rates and therapeutic inertia, the authors sought to evaluate how the 2017 target-lowering guideline and COVID-19 pandemic affected early hypertension management.
Does the initiation of antihypertensive medication across different guideline and pandemic eras improve blood pressure control in US Veterans newly diagnosed with hypertension?
Cohort (n=271,496)
Yes
Does the initiation of antihypertensive medication across different guideline and pandemic eras improve blood pressure control in US Veterans newly diagnosed with hypertension?
Absolute Event Rate: 131.6% vs 131.7%
p-value: p=0.04 for Period 2 vs 1, 0.83 for Period 3 vs 2
Despite the introduction of stricter blood pressure guidelines in 2017, early hypertension control rates among US Veterans remained largely unchanged and suboptimal, highlighting persistent clinical inertia.
BP control rates stayed stable despite 2017 guidelines; leaves open whether implementation strategies can overcome inertia in veterans.
BACKGROUND: Amid persistently low blood pressure (BP) control rates and pervasive therapeutic inertia, we evaluated trends in pre- and posttreatment BP before and after 2 major disruptions (the 2017 target‑lowering guideline and the COVID‑19 pandemic) to assess their impact on early hypertension management. METHODS: This retrospective cohort study of national Veterans Health Administration data included outpatient adults newly diagnosed with hypertension and starting antihypertensive medication between November 13, 2014, and May 31, 2023 (index date). Patients were stratified into 3 periods corresponding to preguideline/prepandemic (Period 1), postguideline/prepandemic (Period 2), and postguideline/postpandemic (Period 3), and into 3 pretreatment systolic BP (SBP) groups based on the average of ≥2 measurements in the 90-day preindex period (<140, 140-160, or ≥160 mm Hg). Across periods, multivariable analyses evaluated: (1) mean posttreatment SBP (mean of measurements from days 180-365 postindex); and (2) posttreatment BP control (<140/90 or <130/80 mm Hg). RESULTS: Among 271 496 Veterans (mean age, 62 years; 92% male; 66% non-Hispanic White), 39%, 32%, and 29% were in Periods 1, 2, and 3, respectively. Adjusted posttreatment SBP across periods was 128, 135, and 142 mm Hg for the <140, 140 to 160, and ≥160 groups, respectively. Rates of posttreatment BP control <140/90 mm Hg across Periods 1, 2, and 3, respectively, were 82.3%, 83.3%, and 84.2% (SBP <140 group); 64.1%, 66.1%, and 67.3% (140-160 group); and 46.4%, 47.0%, and 48.6% (≥160 group). For BP control <130/80 mm Hg, rates were 38.2%, 40.0%, and 39.9% (SBP <140 group); 20.7%, 22.0%, and 22.6% (140-160 group); and 15.1%, 15.4%, and 15.2% (≥160 group). CONCLUSIONS: Despite the target-lowering guideline and the care-disrupting pandemic, BP levels and control among Veterans remained largely unchanged. At 1 year, only half to two-thirds achieved BP <140/90 mm Hg, and few reached <130/80 mm Hg, underscoring persistent clinical inertia and the need to improve early hypertension management in the Veterans Health Administration.
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Derington et al. (2026) conducted a cohort in Hypertension (n=271,496). Time period of antihypertensive medication initiation (2014-2023) vs. Pre-guideline/pre-pandemic period was evaluated on Mean one-year post-treatment systolic blood pressure (overall) (p=0.04 for Period 2 vs 1, 0.83 for Period 3 vs 2). Despite the 2017 target-lowering guideline and the COVID-19 pandemic, one-year post-treatment blood pressure levels and control rates among US Veterans initiating antihypertensive therapy remained largely unchanged.