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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
PubMed

Insights

Despite guideline changes and the COVID-19 pandemic, hypertension management in Veterans showed minimal improvement. Blood pressure (BP) control rates remained low, highlighting persistent clinical inertia in early hypertension treatment.

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 control 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) at 1 year.

Main Results:

  • Adjusted posttreatment SBP showed minimal variation across periods for different baseline SBP groups.
  • BP control rates (<140/90 mm Hg) at 1 year ranged from 46.4% to 84.2%, with slight increases across periods.
  • BP control rates (<130/80 mm Hg) at 1 year were low, ranging from 15.1% to 40.0%, with minimal changes across periods.

Conclusions:

  • Despite a target-lowering guideline and the pandemic, BP levels and control in Veterans remained largely unchanged.
  • A significant proportion of Veterans did not achieve recommended BP targets within one year of treatment initiation.
  • Persistent clinical inertia necessitates improved strategies for early hypertension management within the Veterans Health Administration.
Abstract

Keywords:
adulthypertensionmiddle agedoutpatientspandemics

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