Circulation. Population health and outcomes · 2026
Blood Pressure Outcomes Among US Veterans Initiating Hypertension Treatment, 2014 to 2023.
СтатьяНазвание и аннотация: Перевод в очереди
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Derington Catherine G, Li Haojia, Zhang Yue, Lu Chao-Chin, Jaeger Byron C, Cohen Jordana B, Muntner Paul, Shimbo Daichi, Cushman William C, Berlowitz Dan R, Raghavan Sridharan, Ho P Michael, Hausmann Leslie R M, Bress Adam P, Mohanty April F
Аннотация
BACKGROUND: Amid persistently low blood pressure (BP) control rates and pervasive therapeutic inertia, we evaluated trends in pre- and posttreatment BP before and after 2 major disruptions (the 2017 target‑lowering guideline and the COVID‑19 pandemic) to assess their impact on early hypertension management.
METHODS: This retrospective cohort study of national Veterans Health Administration data included outpatient adults newly diagnosed with hypertension and starting antihypertensive medication between November 13, 2014, and May 31, 2023 (index date). Patients were stratified into 3 periods corresponding to preguideline/prepandemic (Period 1), postguideline/prepandemic (Period 2), and postguideline/postpandemic (Period 3), and into 3 pretreatment systolic BP (SBP) groups based on the average of ≥2 measurements in the 90-day preindex period (<140, 140-160, or ≥160 mm Hg). Across periods, multivariable analyses evaluated: (1) mean posttreatment SBP (mean of measurements from days 180-365 postindex); and (2) posttreatment BP control (<140/90 or <130/80 mm Hg).
RESULTS: Among 271 496 Veterans (mean age, 62 years; 92% male; 66% non-Hispanic White), 39%, 32%, and 29% were in Periods 1, 2, and 3, respectively. Adjusted posttreatment SBP across periods was 128, 135, and 142 mm Hg for the <140, 140 to 160, and ≥160 groups, respectively. Rates of posttreatment BP control <140/90 mm Hg across Periods 1, 2, and 3, respectively, were 82.3%, 83.3%, and 84.2% (SBP <140 group); 64.1%, 66.1%, and 67.3% (140-160 group); and 46.4%, 47.0%, and 48.6% (≥160 group). For BP control <130/80 mm Hg, rates were 38.2%, 40.0%, and 39.9% (SBP <140 group); 20.7%, 22.0%, and 22.6% (140-160 group); and 15.1%, 15.4%, and 15.2% (≥160 group).
CONCLUSIONS: Despite the target-lowering guideline and the care-disrupting pandemic, BP levels and control among Veterans remained largely unchanged. At 1 year, only half to two-thirds achieved BP <140/90 mm Hg, and few reached <130/80 mm Hg, underscoring persistent clinical inertia and the need to improve early hypertension management in the Veterans Health Administration.
METHODS: This retrospective cohort study of national Veterans Health Administration data included outpatient adults newly diagnosed with hypertension and starting antihypertensive medication between November 13, 2014, and May 31, 2023 (index date). Patients were stratified into 3 periods corresponding to preguideline/prepandemic (Period 1), postguideline/prepandemic (Period 2), and postguideline/postpandemic (Period 3), and into 3 pretreatment systolic BP (SBP) groups based on the average of ≥2 measurements in the 90-day preindex period (<140, 140-160, or ≥160 mm Hg). Across periods, multivariable analyses evaluated: (1) mean posttreatment SBP (mean of measurements from days 180-365 postindex); and (2) posttreatment BP control (<140/90 or <130/80 mm Hg).
RESULTS: Among 271 496 Veterans (mean age, 62 years; 92% male; 66% non-Hispanic White), 39%, 32%, and 29% were in Periods 1, 2, and 3, respectively. Adjusted posttreatment SBP across periods was 128, 135, and 142 mm Hg for the <140, 140 to 160, and ≥160 groups, respectively. Rates of posttreatment BP control <140/90 mm Hg across Periods 1, 2, and 3, respectively, were 82.3%, 83.3%, and 84.2% (SBP <140 group); 64.1%, 66.1%, and 67.3% (140-160 group); and 46.4%, 47.0%, and 48.6% (≥160 group). For BP control <130/80 mm Hg, rates were 38.2%, 40.0%, and 39.9% (SBP <140 group); 20.7%, 22.0%, and 22.6% (140-160 group); and 15.1%, 15.4%, and 15.2% (≥160 group).
CONCLUSIONS: Despite the target-lowering guideline and the care-disrupting pandemic, BP levels and control among Veterans remained largely unchanged. At 1 year, only half to two-thirds achieved BP <140/90 mm Hg, and few reached <130/80 mm Hg, underscoring persistent clinical inertia and the need to improve early hypertension management in the Veterans Health Administration.