ArticleHypertension (Dallas, Tex. : 1979)2009
Intensifying therapy for hypertension despite suboptimal adherence.
Article in Hypertension (Dallas, Tex. : 1979), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association.Hypertension (Dallas, Tex. : 1979) · 2018Guideline
- Clinical Decision Support System, Antihypertensive Treatment Intensification, and Blood Pressure Control: A Post Hoc Secondary Analysis of a Cluster Randomized Trial.JAMA network open · 2026Trial
- Pharmacist intervention for blood pressure control: medication intensification and adherence.Journal of the American Society of Hypertension : JASH · 2015Trial
- Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence.Journal of the American Society of Hypertension : JASHTrial
- Clinical inertia in cardiovascular risk management: prevalence, associated factors, and impact on outcomes of the OPM study.Journal of global health · 2026Article
- Blood Pressure Control and Mortality Among US Veterans.Hypertension (Dallas, Tex. : 1979) · 2026Article
- A clinical trial evaluating pharmacist-guided self-management of hypertension among veterans with CKD, rationale and study design.Contemporary clinical trials · 2025Article
- Article
- Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals.Circulation. Cardiovascular quality and outcomes · 2019Article
- Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea.Diabetic medicine : a journal of the British Diabetic Association · 2019Article
- Medication adherence and treatment-resistant hypertension: a review.Drugs in context · 2019Review
- Treatment Intensification for Hypertension in US Ambulatory Medical Care.Journal of the American Heart Association · 2016Article
- No Time to Waste: in Support of Aggressive and Immediate Management of Hypertension.Current hypertension reports · 2016Review
- Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study.BMC research notes · 2016Article
- Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model.Journal of general internal medicine · 2015Article
- Medication adherence and resistant hypertension.Journal of human hypertension · 2015Review
- Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure.Stroke · 2015Article
- Patterns of nonadherence to antihypertensive therapy in primary care.Journal of clinical hypertension (Greenwich, Conn.) · 2013Article
- Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?PloS one · 2013Article
- Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study.European journal of clinical pharmacology · 2012Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
More intensive management can improve control blood pressure (BP) in hypertensive patients. However, many would posit that treatment intensification (TI) is not beneficial in the face of suboptimal adherence. We investigated whether the effect of TI on BP varies by adherence. We enrolled 819 patients with hypertension, managed in primary care at an academically-affiliated inner-city hospital. We used the following formula to characterize TI: (visits with a medication change-visits with elevated BP)/total visits. Adherence was characterized using electronic monitoring devices ("MEMS caps"). Patients who returned their MEMS caps (671) were divided into quartiles of adherence, whereas patients who did not return their MEMS caps (148) had "missing" adherence. We examined the relationship between TI and the final systolic blood pressure (SBP), controlling for patient-level covariates. In the entire sample, each additional therapy increase per 10 visits predicted a 2.0 mm Hg decrease in final SBP (P<0.001). After stratifying by adherence, in the "best" adherence quartile each therapy increase predicted a 2.1-mm Hg decrease in final SBP, followed by 1.8 for the "next-best" adherence quartile, 2.3 in the third quartile, and 2.4 in the "worst" adherence quartile. The effect size for patients with "missing" adherence was 1.6 mm Hg. The differences between the group with "best" adherence and the other 4 groups were not statistically significant. In this observational study, treatment intensification was associated with similar BP improvement regardless of the patient's level of adherence. A randomized trial could further examine optimal management of patients with suboptimal adherence.
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