Key result
Receiving JNC7-concordant antihypertensive therapy was associated with a higher likelihood of achieving blood pressure control compared to discordant therapy.
Why the study?
Does JNC7-concordant antihypertensive therapy improve blood pressure control in incident hypertensive patients?
Cohort (n=14,910)
Yes
Does JNC7-concordant antihypertensive therapy improve blood pressure control in incident hypertensive patients?
Adherence to JNC7 hypertension guidelines for initial therapy significantly increases the odds of achieving blood pressure control, though guideline concordance drops substantially in higher-risk patients.
Answers are grounded in this paper and cite their sources.
Concordant therapy was associated with better BP control; leaves open causality and need for prospective confirmation before practice change.
PURPOSE: To describe initial antihypertensive management relative to important aspects of JNC7 hypertension guidelines, to identify predictors of receiving JNC7 discordant therapy, and to determine the association between receiving JNC7-concordant antihypertensive treatment and achieving blood pressure (BP) control. This study focused on aspects of the JNC7 guidelines which are consistent with other guidelines that have been published since JNC7. METHODS: EMR data from eleven multi-specialty medical groups in the US were retrospectively collected between 2008-2011. The study cohort included incident hypertensive patients who received an antihypertensive prescription during the 6-month follow-up period. Patients with existing hypertension were excluded. JNC7-concordance of the prescribed antihypertensive regimen was evaluated. Using multivariable logistic regression, we determined the association between JNC7-concordance and achieving BP control. Additionally, we determined predictors of receiving JNC7-discordant treatment. RESULTS: 14,910 incident hypertensive patients who were treated with an antihypertensive during the 6-month follow-up period were included. Overall, 79.4% patients were prescribed antihypertensive therapy concordant with JNC7; however among patients with stage 2 hypertension, the concordance was found to be 50%. BP control was achieved by 64.1% and 48.5% of patients who received JNC7-concordant and JNC7-discordant therapy, respectively. The overall adjusted odds ratio (95% CI) for BP control and JNC7-concordance was 1.53 (1.40, 1.68). The association was attenuated for cohort members with diabetes, chronic kidney disease (CKD), and stage 2 hypertension. Predictors of receiving JNC7-discordant therapy were congestive heart failure, CKD, and diabetes. CONCLUSION: JNC7-concordance is high overall, but drops substantially when JNC7 recommendations are more demanding (e.g., among patients with stage 2 hypertension and/or CKD, CHF, diabetes). Overall, patients who are prescribed an antihypertensive regimen that is JNC7-concordant are more likely to achieve BP control.
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Rowan et al. (2014) conducted a cohort in Incident hypertension (n=14,910). JNC7-concordant antihypertensive treatment vs. JNC7-discordant antihypertensive treatment was evaluated on Achieving blood pressure (BP) control (OR 1.53, 95% CI 1.40, 1.68). Receiving JNC7-concordant antihypertensive therapy was associated with a higher likelihood of achieving blood pressure control compared to discordant therapy.
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