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Evaluating alternative methods of comparing antihypertensive treatment intensity
Carole E Aubert1, Chiao-Li Chan, Samuel W Terman
1Department of General Internal Medicine, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland.
The American Journal of Managed Care
|May 13, 2022
Summary
Measuring medication dose changes provides a more accurate picture of hypertension treatment adjustments than simply counting pills. This approach better captures changes in treatment intensity for improved patient care.
Area of Science:
- Pharmacology
- Health Services Research
- Geriatric Medicine
Background:
- Clinicians adjust blood pressure treatment by altering medication count or dose.
- Existing studies often focus on medication count, potentially overlooking significant dose modifications without count changes.
Purpose of the Study:
- To demonstrate that dose modification captures more comprehensive information about hypertension management than medication count alone.
- To introduce a validated algorithm for standardized dose change measurement.
Main Methods:
- Retrospective cohort study of 65+ year old Veterans Health Administration patients (July 2011-June 2013).
- Utilized a validated pharmacy fill algorithm to capture medication count and standardized dose change over 90-120 days.
- Analyzed frequency of dose-only changes, count-only changes, concordant changes, and discordant changes, comparing them against systolic blood pressure (SBP) thresholds.
Main Results:
- Dose modification occurred in 64.2% of 440,801 patients, compared to 22.0% for count change.
- A significant 42.4% experienced dose change without any count modification.
- Treatment adjustments were more frequent when systolic blood pressure exceeded 140 mm Hg.
Conclusions:
- Medication count alone frequently misses isolated dose changes in antihypertensive treatment.
- Measuring dose modification offers a more precise method for assessing hypertension treatment intensity compared to current count-based methods.
- Future research should incorporate dose modification algorithms for more accurate treatment evaluation.
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