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Author Spotlight: A Pharmacodissection Approach to Uncover Mechanisms in Cardiovascular Disease Risk Populations
Published on: July 21, 2023
Observational study and participant-level meta-analysis on antihypertensive drug treatment-related cardiovascular
Kei Asayama1,2
1Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Insights
Home blood pressure monitoring is crucial for managing hypertension. Self-measured readings better predict cardiovascular outcomes in treated patients than standard measurements, guiding long-term treatment effectively.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Antihypertensive therapy reduces cardiovascular risk, yet treated individuals often have poorer outcomes than untreated ones.
- Conventional blood pressure measurements at baseline show weak association with cardiovascular events in medicated patients.
- Hypertension requires long-term monitoring and management.
Purpose of the Study:
- To evaluate the impact of conventional blood pressure versus self-measured home blood pressure on cardiovascular outcomes in patients undergoing antihypertensive treatment.
- To determine the optimal method for long-term hypertension management and cardiovascular risk assessment in treated individuals.
Main Methods:
- Analysis of two Japanese individual participant databases (Ohasama and the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressures study).
- Comparison of cardiovascular event prediction using conventional blood pressure versus self-measured home blood pressure in patients on antihypertensive medication.
Main Results:
- Conventional blood pressure at baseline was not or weakly associated with cardiovascular events in patients on antihypertensive drugs.
- Self-measured home blood pressure significantly predicted cardiovascular outcomes in patients under antihypertensive treatment.
- This suggests home blood pressure monitoring is a more reliable indicator for managing treated hypertension.
Conclusions:
- Long-term management of hypertension, even with antihypertensive drug treatment, should likely be based on self-measured home blood pressure.
- Close attention must be paid to residual cardiovascular risk in patients receiving treatment.
- Home blood pressure monitoring offers a more accurate approach to assessing cardiovascular risk in treated hypertensive individuals.
Abstract:
Although antihypertensive therapy reduces cardiovascular risk, individuals who are treated with antihypertensive medication generally have a worse prognosis for cardiovascular disease than untreated people. We recently evaluated the impact of conventional blood pressure level based on two Japanese individual participant databases and found that conventional blood pressure at baseline was not or was weakly associated with cardiovascular events among patients under antihypertensive drug medication. In the general population in Ohasama and the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressures study, self-measured home blood pressure significantly predicted cardiovascular outcomes in patients under antihypertensive treatment. Hypertension is a chronic disease, and blood pressure must be evaluated with repeated measurements over a long period of time. Therefore, although not proven by a randomized controlled trial, it is likely that the long-term management of hypertension by antihypertensive drug treatment should be based on self-measured home blood pressure. We should also pay careful attention to the residual cardiovascular risk in treated patients.
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