Treatment in the First Month After Hypertension Diagnosis Improves Blood Pressure Control

Adults with hypertension have fewer cardiovascular events if controlled within the first 6 months of diagnosis, during which time they are excluded from many hypertension control metrics. We compared blood pressure (BP, mm Hg) control rates from 6 to 42 months in adults with hypertension who did or did not have antihypertensive treatment initiated (TI) with monotherapy during the first month after diagnosis, irrespective of subsequent changes in antihypertensive pharmacotherapy.

A retrospective cohort of 15 422 patients, mean age 56.0±14.8 years, from 5 health care organizations, was identified with previously undiagnosed and untreated hypertension. BP control (<140/<90) and TI on visits with uncontrolled readings were assessed as a function of time since diagnosis, up to 42 months. Logistic regression models provided estimates of the odds of TI for initial BP, stratified by race, sex, and diagnosed diabetes. Cox proportional hazards regression estimated the hazard ratio of BP control over time.

Patients with TI during the first month versus later time points had better BP control at 6 (57.7% versus 47.8%, P<0.001) through 30 months (66.8% versus 62.2%, P<0.001), with similar control rates thereafter.

TI within the first month after diagnosis in contrast to later time points, leads to better BP control at 6 to 30 months, which is associated with better clinical outcomes and performance on standard hypertension control metrics. While better control is sustained for 30 months, treatment with monotherapy during the first month following diagnosis was insufficient to control hypertension in >30% of patients.