Key result
Adding a new antihypertensive medication was associated with less intensification sustainability (ATE -15.1%; 95% CI -15.6 to -14.5) but a slightly larger SBP reduction than maximizing dose.
Why the study?
When target blood pressure is not reached, it is unknown whether adding a new medication or maximizing dose is the better intensification strategy.
Does adding a new medication compared to maximizing the dose of an existing medication improve treatment sustainability and reduce systolic blood pressure in older adults with hypertension?
Cohort (n=178,562)
Does adding a new medication compared to maximizing the dose of an existing medication improve treatment sustainability and reduce systolic blood pressure in older adults with hypertension?
In older adults with hypertension, adding a new medication rather than maximizing the dose of an existing one results in slightly greater blood pressure reduction but lower long-term treatment sustainability.
May favor dose maximization for sustainability despite modest SBP gains in older adults; leaves open optimal strategy pending randomized confirmation.
BACKGROUND: There are 2 approaches to intensifying antihypertensive treatment when target blood pressure is not reached, adding a new medication and maximizing dose. Which strategy is better is unknown. OBJECTIVE: To assess the frequency of intensification by adding a new medication versus maximizing dose, as well as the association of each method with intensification sustainability and follow-up systolic blood pressure (SBP). DESIGN: Large-scale, population-based, retrospective cohort study. Observational data were used to emulate a target trial with 2 groups, new medication and maximizing dose, who underwent intensification of their drug regimen. SETTING: Veterans Health Administration (2011 to 2013). PATIENTS: Veterans aged 65 years or older with hypertension, an SBP of 130 mm Hg or higher, and at least 1 antihypertensive medication at less than the maximum dose. MEASUREMENTS: new medication. Inverse probability weighting was used to assess the observational effectiveness of the intensification approach on sustainability of intensified treatment and follow-up SBP at 3 and 12 months. RESULTS: Among 178 562 patients, 45 575 (25.5%) had intensification by adding a new medication and 132 987 (74.5%) by maximizing dose. Compared with maximizing dose, adding a new medication was associated with less intensification sustainability (average treatment effect, -15.2% [95% CI, -15.7% to -14.6%] at 3 months and -15.1% [CI, -15.6% to -14.5%] at 12 months) but a slightly larger reduction in mean SBP (-0.8 mm Hg [CI, -1.2 to -0.4 mm Hg] at 3 months and -1.1 mm Hg [CI, -1.6 to -0.6 mm Hg] at 12 months). LIMITATION: Observational data; largely male population. CONCLUSION: Adding a new antihypertensive medication was less frequent and was associated with less intensification sustainability but slightly larger reductions in SBP. Trials would provide the most definitive support for our findings. PRIMARY FUNDING SOURCE: National Institute on Aging and Veterans Health Administration.
No takes yet. Share an insight, caveat, or question.
Aubert et al. (2021) conducted a cohort in hypertension (n=178,562). Adding a new medication vs. Maximizing dose was evaluated on intensification sustainability at 12 months (ATE -15.1%, 95% CI -15.6 to -14.5). Adding a new antihypertensive medication was associated with less intensification sustainability (ATE -15.1%; 95% CI -15.6 to -14.5) but a slightly larger SBP reduction than maximizing dose.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: