Key result
Directly observed therapy at the hospital significantly reduced systolic blood pressure at 7 months post-discharge by 27.3 mm Hg (95% CI -35.5 to -19.1) despite fewer antihypertensive classes.
Why the study?
The study evaluated the impact of in-hospital directly observed therapy on adherence, diagnosis, and post-discharge blood pressure control in patients with clinically suspected resistant or refractory hypertension.
Does directly observed therapy at hospital improve diagnosis and blood pressure control in patients with suspected resistant or refractory hypertension?
Cohort (n=83)
Does directly observed therapy at hospital improve diagnosis and blood pressure control in patients with suspected resistant or refractory hypertension?
Mean Difference: -27.3 (95% CI -35.5–-19.1)
Directly observed therapy in a hospital setting helps confirm true resistant/refractory hypertension and leads to sustained blood pressure reductions with fewer medications up to 7 months post-discharge.
DOT may confirm RHTN/RefHTN phenotypes and sustain post-discharge BP control with fewer drugs; leaves open need for randomized trials.
OBJECTIVE: To test the impact of directly observed therapy (DOT) at hospital for checking not only adherence/diagnosis in patients with resistant (RHTN) and refractory (RefHTN) hypertension but also blood pressure (BP) control after hospital discharge. METHODS: During 2 years, Brazilian patients with clinical suspicion of RHTN/RefHTN after several attempts (≥3) to control BP in the outpatient setting were invited to perform DOT (including low-sodium diet and supervised medications intake) at the hospital. RHTN and RefHTN were categorised using standard definitions. After hospital discharge, we evaluated the BP values and the number of antihypertensive drugs prescribed by physicians who were not involved with the investigation. RESULTS: We studied 83 patients clinically suspected for RHTN (31%) and RefHTN (69%) (mean age: 53 years; 76% female; systolic BP 177±28 mm Hg and diastolic BP 106±21 mm Hg; number of antihypertensive drugs: 5.3±1.3). DOT confirmed RHTN in 77%, whereas RefHTN was confirmed in only 32.5%. The number of antihypertensive drugs reduced to 4.5±1.3 and systolic/diastolic BP at hospital discharge reduced to 131±17 mm Hg/80±12 mm Hg. After hospital discharge, systolic BP remained significantly lower than the last outpatient visit prehospital admission (delta changes (95% CI): 1 month: -25.7 (-33.8 to -17.6) mm Hg; 7 months: -27.3 (-35.5 to -19.1) mm Hg) despite fewer number of antihypertensive classes (1 month: -1.01 (-1.36 to -0.67); 7 months: -0.77 (-1.11 to -0.42)). Similar reductions were observed for diastolic BP. CONCLUSIONS: DOT at hospital is helpful not only in confirming/excluding RHTN/RefHTN phenotypes, but also in improving BP values and BP control and in reducing the need for antihypertensive drugs after hospital discharge.
No takes yet. Share an insight, caveat, or question.
Pio-Abreu et al. (2022) conducted a cohort in Resistant and refractory hypertension (n=83). Directly observed therapy (DOT) at hospital vs. Prehospital admission baseline was evaluated on Systolic blood pressure change at 7 months after hospital discharge (MD -27.3 mm Hg, 95% CI -35.5 to -19.1). Directly observed therapy at the hospital significantly reduced systolic blood pressure at 7 months post-discharge by 27.3 mm Hg (95% CI -35.5 to -19.1) despite fewer antihypertensive classes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: