New research presented at the annual scientific meeting of American Society of Hypertension from May 21-24 in New York City addressed important issues in the management of high blood pressure. The features below highlight just some of the studies that emerged from the meeting.
The Particulars: Aggressive treatment of older patients with hypertension has been largely avoided due to a lack of outcomes data and concerns over potential side effects by adding medications. Recent studies have helped begin a change in this mindset.
Data Breakdown: Investigators conducted a study in 183,054 patients aged 70 and older with treated hypertension. Patients were separated into groups based on achieved systolic blood pressure (BP) at 6 months prior to death or last available measurement. Significantly increased rates of all-cause death were seen in those who achieved systolic BP measurements of 140 to 149 mm Hg (17%) and in those with systolic BPs of 150 mm Hg or higher (40%) when compared with those in lower BP ranges. Higher mortality rates were also associated with systolic BP measurements below 130 mm Hg, with relative increases ranging between 22% and 408%.
Take Home Pearl: Among patients aged 70 and older, a systolic BP measurement of 130 to 139 mm Hg appears to be associated with the lowest mortality risk.
Intensive BP Control, Fracture Risk, & Diabetes [back to top]
The Particulars: Physicians have historically been concerned that intensive blood pressure (BP) control in high-risk patients with type 2 diabetes may increase the rate of falls, hypotension, and fractures. Few studies have explored this relationship.
Data Breakdown: Researchers assigned 3,282 older patients (mean age, 62) with type 2 diabetes to intensive BP control (systolic target, <120 mm Hg) or standard treatment (systolic target, <140 mm Hg). After an average 3.6 years follow-up, no differences were seen between groups on the rate of self-reported falls. Among 273 patients with at least one confirmed non-spine fracture (after a mean of 4.9 years), a significantly lower overall rate of non-spine fracture was recorded in the intensive BP control group.
Take Home Pearls: The risk of self-reported falls or fractures does not appear to be higher among patients with type 2 diabetes who receive intensive BP control when compared with those receiving standard care. More studies are needed as the results may not apply to patients aged 80 and older.
Overcoming Clinical Inertia [back to top]
The Particulars: Hypertension rates remain suboptimal despite recent efforts to improve physician education on the importance of effective BP management and enhanced treatments. This disconnect may be the result of clinical inertia, which is defined as “a clinician’s failure to initiate appropriate therapeutic intensification.”
Data Breakdown: In an analysis from 1,824 patient clinic visits, a study team found that no action was taken by clinicians for 63% of cases for which a patient’s BP was not at the recommended goal. Clinical inertia was observed 73% of the time among clinicians who saw more than 26 patients per day. Patient load was a statistically significant factor in determining clinical inertia. Significantly higher clinical inertia was also seen in physicians managing pa-tients whose BP was <10 mm Hg above goal (71%), those with diabetes (70%), and non-Hispanic Caucasians (66%).
Take Home Pearls: Clinical inertia for BP management appears to be strongly influenced by patient loads as well as patient ethnicity, diabetes status, and other factors. Clinicians should be aware of clinical inertia in their practice to improve hypertension control rates.
Readings & Resources (click to view)
For more information on these studies and others that were presented at the 2011 annual scientific meeting of the American Society of Hypertension, go to www.ash-us.org/annual_meeting/index.htm.