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Temporal Patterns in Blood Pressure Management Before and After Recent Clinical Trials and Guideline Recommendations
Eric J Brandt1,2, Craig J Beavers3, Zhuxuan Fu4
1Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Journal of Clinical Hypertension (Greenwich, Conn.)
|March 18, 2025
Summary
This study examined blood pressure (BP) goal achievement and antihypertensive prescribing trends following major hypertension guideline updates. While statistically significant, the observed increase in achieving office-based systolic BP goals was small and minimally relevant.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Public Health
Background:
- Hypertension management guidelines evolve, impacting clinical practice.
- Assessing the real-world impact of guideline changes on patient outcomes is crucial.
- Previous studies have not fully evaluated clinician behavior shifts in response to JNC-8, SPRINT, and the 2017 hypertension guideline.
Purpose of the Study:
- To analyze trends in achieving blood pressure (BP) goals among older adults.
- To evaluate changes in antihypertensive prescribing patterns.
- To determine if clinician behavior temporally correlated with key hypertension guideline publications.
Main Methods:
- Utilized the National Cardiovascular Data Registry (NCDR) Practice INNovation and CLinical Excellence (PINNACLE) registry.
- Included a large cohort of patients aged over 65 years with hypertension (n=3,678,774).
- Analyzed data from 2013 to 2018, focusing on temporal relationships with guideline releases.
Main Results:
- A statistically significant increase in achieving office-based systolic blood pressure (SBP) was observed from 2013 to 2018.
- The observed increase in SBP goal achievement was small and considered minimally clinically relevant.
- Trends in antihypertensive prescribing and overall clinician behavior shifts require further detailed analysis.
Conclusions:
- While guidelines aim to improve BP control, their real-world impact on achieving BP goals may be modest.
- Continued monitoring of clinical practice patterns and patient outcomes is essential.
- Further research is needed to understand the factors influencing the translation of guidelines into significant clinical improvements.
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