Rapid adjustment of antihypertensive drugs produces a durable improvement in blood pressure

Antihypertensive drugs are often initiated and adjusted over a period of we eks to months. It is not clear whether the time and inconvenience of this a pproach is necessary. We studied whether or not drug adjustment over severa l days in the context of a physician-nurse team could produce a durable blo od pressure benefit according to home blood pressure measurements. Sixty-eight patients (aged 65 +/- 1 years, 47% men) were referred for manag ement of hypertension. Indications for referral were new hypertension (13%) , known/controlled hypertension (30%), or known/uncontrolled hypertension ( 57%). Patients had one to three brief nurse visits/day and were provided wi th an accurate semiautomated device for self-blond pressure (BP) measuremen t. Sixty patients provided follow-up data. Group 1 (n = 16) required no cha nge in their preexisting drug regimen during clinic visits, whereas group 2 (n = 44) had drug therapy initiated or adjusted over 4 +/- 1 days. Patient s were evaluated at baseline, at dismissal from the clinic, and at latest f ollow-up (mailed-in report of 42 readings taken over 7 days at 1- to 3-mont h intervals). Mean follow-up was 11 +/- 0.5 months. Mean BP at baseline, dismissal, and l atest follow-up for group 1 were 132 +/- 4/73 +/- 2, 130 +/- 6/70 +/- 2, an d 125 +/- 3/73 +/-: 3 mm Hg (P = not significant). Mean BP for group 2 at t he same intervals were 150 +/- 4/80 +/- 2, 139 +/- 3 (P < .01 v baseline)/7 5 <plus/minus> 2, 133 +/- 2 (P < .01 v baseline and < .05 v dismissal)/74 /- 1 (P < .01 v baseline). The BP control rate (blood pressures less than 1 40/90 mm Hg) was 75% in group 2. Drug number/dose remained the same or lowe r in 87% and 91% of patients during follow-up in groups 1 and 2, respective ly. These results suggest that a clinically significant lowering of blood press ure can often be achieved over several days and maintained for up to I year . Increased use of rapid drug titration, a physician-nurse team approach, a nd self-BP measurement at prescribed intervals have the potential to improv e BP control rates and reduce the expense and inconvenience associated with the treatment of hypertension. <(c)> 2001 American Journal of Hypertension , Ltd.