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Blood Pressure Outcomes Among US Veterans Initiating Hypertension Treatment, 2014 to 2023
Catherine G Derington1,2, Haojia Li3, Yue Zhang3
1Department of Medicine, University of Colorado School of Medicine, Aurora (C.G.D., S.R.).
Circulation. Population Health and Outcomes
|July 31, 2026
Summary
Despite guideline changes and the COVID-19 pandemic, early hypertension management in Veterans showed minimal improvement. Blood pressure (BP) control rates remained low, highlighting persistent clinical inertia in managing high blood pressure.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Persistently low blood pressure (BP) control rates and therapeutic inertia pose significant challenges in hypertension management.
- Evaluating trends in BP before and after major healthcare disruptions is crucial for understanding early hypertension management.
Purpose of the Study:
- To assess the impact of a 2017 target-lowering guideline and the COVID-19 pandemic on early hypertension management.
- To analyze trends in pre- and posttreatment BP in Veterans newly diagnosed with hypertension.
Main Methods:
- Retrospective cohort study using national Veterans Health Administration data (2014-2023).
- Included outpatients newly diagnosed with hypertension and starting medication.
- Stratified patients into pre-guideline/prepandemic, post-guideline/prepandemic, and post-guideline/postpandemic periods.
- Analyzed mean posttreatment systolic BP (SBP) and BP control rates (<140/90 and <130/80 mm Hg).
Main Results:
- Adjusted posttreatment SBP ranged from 128 to 142 mm Hg across pretreatment SBP groups.
- BP control rates (<140/90 mm Hg) at 1 year were 82-84% (SBP <140), 64-67% (140-160), and 46-49% (≥160).
- BP control rates (<130/80 mm Hg) at 1 year were 38-40% (SBP <140), 20-23% (140-160), and 15-15% (≥160).
Conclusions:
- Despite guideline changes and the pandemic, BP levels and control in Veterans remained largely unchanged.
- Achievement of BP <140/90 mm Hg at 1 year was suboptimal, and <130/80 mm Hg was rarely achieved.
- Persistent clinical inertia necessitates improved strategies for early hypertension management within the Veterans Health Administration.
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