When Blood Pressure Needs More Control, What’s Better: An Additional Drug or More of the Same?
upstart writes:
In a look back at data from nearly 179,000 veterans over age 65 who received treatment over two years at VA hospitals nationwide, researchers find that patients have a better chance of sticking to their medication regimen if their doctor maximizes the dosage of one of the drugs they're already taking. They also found that both strategies decrease blood pressure, but adding a new medication has a very slim advantage over increasing the dose of an existing medication, despite some of the patients being unable to stay on the new medication.
In the end, the researchers say, the new findings could add to discussions between physicians and patients whose blood pressure remains elevated despite starting medication treatment.
The findings [...] focus on patients whose initial systolic blood pressure was above 130 mm Hg.
By looking back at VA and Medicare data, the researchers were able to see patterns in treatment and blood pressure readings over time, in a kind of natural experiment. All the patients were taking at least one blood pressure medication at less than the maximum dose and had a treatment intensification at the start of the study period, indicating that their physicians thought they needed more intense treatment.
Because intensification of blood pressure treatment can come with risks -- whether a drug interaction if a new drug is added, or an electrolyte imbalance with high doses, or fainting and falling if a person's pressure gets too low -- such decisions must be carefully made.
Journal Reference:
Carole E. Aubert, Jeremy B. Sussman, Timothy P. Hofer, et al. Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults, Annals of Internal Medicine (DOI: 10.7326/M21-1456)
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