Ann Arbor, MI—Which is better when patients fail to reach target blood pressure (BP): adding a new medication or maximizing dosage of the current medication?

A new study published in Annals of Internal Medicine sought to answer that question. To do that, University of Michigan—led researchers sought to assess how often patients without adequate response added a new medication as opposed to increasing the dose of the current drug. The authors also looked at the association of each method with intensification sustainability and follow-up systolic blood pressure (SBP).

In the large-scale, population-based, retrospective cohort study, observational data were used to model a target trial with two groups—new medication and maximizing dose—who underwent intensification of their blood pressure—lowering therapy.

The study team used records from the Veterans Health Administration (2011-2013), including patients aged 65 years or older with hypertension, SBP of 130 mmHg or higher, and at least one antihypertensive medication at less than the maximum dose.

Among 178,562 patients, about a fourth had a new medication added, while nearly 75% had their dosage maximized. Results indicate that "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)."

The authors point out that their study has limitations because it is observational and involved a mostly male population.

"Adding a new antihypertensive medication was less frequent and was associated with less intensification sustainability but slightly larger reductions in SBP," the researchers conclude. "Trials would provide the most definitive support for our findings."

A recent study in the American Heart Journal suggests that treating hypertension with antihypertensive medications combinations, rather than one medication, tends to be underused in the United States. That is especially the case in certain race/ethnic groups, according to the University of Utah School of Medicine authors and colleagues.

Among 1,597 participants with hypertension and uncontrolled BP from the National Health and Nutrition Examination Surveys from 2013 to 2014 through 2017 to 2018, researchers found that age- and sex-adjusted prevalence of monotherapy was 42.6% overall, 45.4% among non-Hispanic White, 31.9% among non-Hispanic Black, 39.6% among Hispanic, and 50.9% among non-Hispanic Asian adults.

"Overall, higher SBP was associated with higher monotherapy use, while older age, having a healthcare visit in the previous year, higher body mass index, and having heart failure were associated with lower monotherapy use," the study concludes.

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