What question did this study set out to answer?

To assess how evolving Joint National Committee guidelines influenced initial antihypertensive drug selection and subsequent one-year clinical outcomes in untreated hypertensive patients.

May 1, 1996American Journal of HypertensionOpen Access

Antihypertensive drug therapy The effect of JNC criteria on prescribing patterns and patient status through the first year

View Full Paper

Ask AI

Bookmark

Why the study?

Does protocol-driven antihypertensive therapy guided by JNC criteria impact prescribing patterns and patient outcomes in untreated hypertensive patients?

Population

550 presumably untreated patients with high blood pressure in a systematic hypertension control program for…

Comparison

Protocol-driven antihypertensive monotherapy… vs Comparison across the three representative time…

Design

Cohort

Follow-up

1 year

Authors

MAMichael H. AldermanPreventive Cardiology

Discussion

Member takes

Implication

Similar 1-year BP control despite prescribing shifts; leaves open whether reduced dropout improves long-term adherence in hypertension.

Key Points

To assess how evolving Joint National Committee guidelines influenced initial antihypertensive drug selection and subsequent one-year clinical outcomes in untreated hypertensive patients.
Observational cohort study tracking 550 untreated union employees in New York City who initiated monotherapy across three guideline periods: pre-JNC IV (1986–1987, N=231), post-JNC IV (1990–1991, N=213), and JNC V (1992, N=106).
Monotherapy was prescribed from four drug classes (diuretics, beta-blockers, calcium channel blockers, or ACE inhibitors), with follow-up extending through one year of treatment.
Outcomes included the initial drug class selected, one-year blood pressure control, clinical chemistry parameters, medication continuation rates, scheduled clinic attendance, and program dropouts.
Initial prescriptions shifted from 85%–90% receiving diuretics or beta-blockers in Period I to 90% receiving calcium channel blockers or ACE inhibitors in Period II, before leveling to an even distribution across classes in Period III.
Blood pressure response remained consistent across the three cohorts at 135/89 mm Hg (Period I), 138/89 mm Hg (Period II), and 140/89 mm Hg (Period III), with similar initial medication continuation rates (60%, 67%, and 69%).
Scheduled clinic visits decreased from 7.4 in Period I to 6.4 in Period III (P = .004), while dropout rates fell significantly from 17% in Period I to 10% in Period II and 9% in Period III (P = .045 for I vs II or III).

Structured PICO

Does protocol-driven antihypertensive therapy guided by JNC criteria impact prescribing patterns and patient outcomes in untreated hypertensive patients?

Population

550 presumably untreated patients with high blood pressure in a systematic hypertension control program for union employees in New York City.

Intervention

Protocol-driven antihypertensive monotherapy guided by Joint National Committee (JNC) recommendations (diuretics, beta-blockers, calcium channel blockers, or angiotensin converting enzyme inhibitors) during three periods: I-pre-JNC IV (1986-1987); II-post-JNC IV (1990-1991); and III-JNC V (1992).

Comparator

Comparison across the three representative time periods (Period I vs Period II vs Period III).

Outcome

Type of drug first prescribed and outcomes at the end of 1 year (changes in blood pressure, clinical chemistry measures and therapy, clinic attendance, and dropout rate).surrogate

Dramatic shifts in the choice of initial antihypertensive drug based on JNC guidelines had little discernable impact on short-term blood pressure outcomes, though clinic attendance and dropout rates improved.

Cite This Study

Michael H. Alderman (1996) studied this question.

synapsesocial.com/papers/6a79ddeae357fbdac58940ad https://doi.org/10.1016/0895-7061(95)00438-6

Topics

Hypertension management

View Full Paper

Ask AI

Bookmark

Antihypertensive drug therapy The effect of JNC criteria on prescribing patterns and patient status through the first year

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Antihypertensive drug therapy The effect of JNC criteria on prescribing patterns and patient status through the first year

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider