This British retrospective cohort study investigated the optimal systolic blood pressure goal above which new antihypertensive medications should be added or doses of existing medications increased (“systolic intensification threshold”) and it also examined the link between delays in medication intensification and follow-up and the risk of cardiovascular events or death. Its researchers state its findings support the importance of avoiding delays in medical management and follow-up in the treatment of patients with hypertension.
An editorial suggests caution in interpreting the findings bearing in mind the limitations of observational research and of using electronic primary care records. Nevertheless, it acknowledges that there are useful messages from this research for GPs in that it provides some corroborative evidence for the treatment thresholds advocated by current guidelines and reinforces the importance of timeliness in establishing a diagnosis of hypertension, intensifying treatment when blood pressure remains above target and scheduling follow-up after treatment intensification. It adds that one way of achieving better adherence to guideline thresholds, along with timely intervention and follow-up, is to give more control to patients, as those who self-manage their hypertension achieve lower blood pressures than those managed with usual care, and patients who simply self-monitor also have better control of their blood pressure.