Study Finds Hypertension Treatment Timing Critical
According to a recently published report, delaying treatment intensification and follow-up care in patients with high blood pressure can prove fatal.
Researchers at Brigham and Women’s Hospital and of the Beth Israel Deaconess Medical Center in Boston reported in BMJ in February that three factors increase the risk of acute cardiovascular events or death in patients with hypertension. These three factors are: patients whose systolic blood pressure or SPB is greater than 150 mm Hg, delay of treatment intensification by more than 1.4 months, and delay in subsequent follow-up by more than 2.7 months.
The results of the study indicate that medical professionals need to be seeing these patients more often. Following up any later may increase the instance of adverse outcomes. However, scheduling the necessary patient visits may be a problem because of the strain on primary care services. Even when working with physicians’ assistants and nurse practitioners, patients may have longer waits before seeing their doctors.
The lack of time for visits to primary care providers applies to patients and doctors. Patients have jobs and they have to take time off work to see the doctor. They have kids and other obligations to schedule appointments around intensifying treatment means coming back more and more often, and a lot of times this is simply not an option for them. Regardless, it is important to figure out a way to get patients seen by someone, somehow.
Hypertension control is not just a United States issue. The Centers for Disease Control and Prevention (CDC) has been working with other public health entities to tackle high blood pressure on a global level. An estimated 1 million people worldwide suffer from high blood pressure issues. Getting just half of them and treatment could prevent 10 million heart attacks and strokes through the year 2025. Every year, 9.4 million people die as a result of high blood pressure.
Too often, doctors do not give blood pressure control the urgency requires. Patients with mildly elevated blood pressure may be given a little more time to work on their diet and exercise. What doctors should be doing is increasing their medication, letting them make changes to their diet and exercise and then, as they make improvements, back off medication.
In 2014, the Eighth Joint National Committee (JNC 8) released national guidelines that recommend beginning drug therapy for patients under 60 years of age whose SBP exceeds 140 mm Hg, and for patients over age 60 whose SBP exceeds 150 mm Hg. Both of these recommendations are made based on strong evidence from scientific literature.
JNC 8 recommends assessing the response therapy after one month, and increasing therapy for patients who have not achieved SBP goals, based on expert opinion. The study’s findings support the expert opinion, so doctors should consider this when making their choices with patients.