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Publication Briefs

Article Suggests Achieving Blood Pressure Control within Three Months Should be New Therapy Goal

"Start low, go slow" has been the paradigm guiding the drug treatment of hypertension for many years. Patients start on low doses of a single medication; if control is not achieved the dosage is gradually increased or additional medications are started. Yet studies persistently show that by using this method the majority of patients with hypertension do not achieve adequate blood pressure control, and recent hypertension clinical trials offer evidence that initial failure to treat blood pressure aggressively makes it less likely that control will ever be achieved. In addition, while current guidelines emphasize the use of drug combinations to achieve BP control, they do not emphasize time to control.

The authors argue that to improve cardiovascular outcomes, evidence now indicates that a new paradigm emphasizing the rapid achievement of blood pressure control is required. Central to this paradigm is an explicit expectation of the timeframe in which blood pressure control should be achieved. Higher rates of control in shorter time periods have been seen in more recent clinical trials, and rapid blood pressure control is safe and associated with few side effects. Thus, the authors believe that the balance of the evidence supports changing the paradigm of hypertension treatment and implementing an expectation that blood pressure control should be achieved within three months of starting medication therapy. Such an explicit expectation also would help guide clinicians and provide a benchmark for which they could strive.

Berlowitz D and Franklin S. The clock is ticking: The case for achieving more rapid control of hypertension. Journal of Clinical Hypertension May 2010;12(5):323-27.

This study was funded by HSR&D (SDR 99-300). Dr. Berlowitz is Director of HSR&D’s Center for Health Quality, Outcomes and Economic Research in Bedford, MA.

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