Comparative Efficacy of Hypertension Management Strategies

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Hypertension (HTN) is a primary cardiovascular risk factor and a significant public health concern in the U.S.
• Existing therapeutic advances for HTN management show gaps between clinical trial outcomes and real-world practice.

Purpose of the Study:

• To evaluate and compare the efficacy of different antihypertensive medication adjustment strategies in a real-world clinical setting.
• To identify which antihypertensive strategies are most effective in reducing systolic blood pressure (SBP).

Main Methods:

• Retrospective analysis of 332 adult patients with HTN treated at a hospital clinic between 2016 and 2022.
• Patients were categorized by treatment strategy: adding medication (AM), increasing dosage (ID), switching medications (SM), dropped medications (DrM), or no change (NC).
• Systolic blood pressure (SBP) changes were analyzed using linear regression at 3- and 12-month follow-ups.

Main Results:

• Adding medication (AM) resulted in the greatest reduction in SBP, with an adjusted ∆SBP of -11 mm Hg at 3 months (p < 0.001) and -9 mm Hg at 12 months (p = 0.006).
• Increasing dosage (ID) showed a trend towards SBP reduction (-8.5 mm Hg at 3 months, p = 0.074; -7 mm Hg at 12 months, p = 0.3), but was not statistically significant compared to AM.
• Switching medications (SM) demonstrated minimal impact on SBP reduction (-3 mm Hg at both 3 and 12 months).

Conclusions:

• Adding antihypertensive medication is a highly effective strategy for reducing SBP in patients with HTN.
• While increasing dosage may offer some benefit, it appears less effective than adding new medication.
• These findings underscore the importance of tailored antihypertensive medication adjustment strategies for optimal patient outcomes.