ArticleCirculation. Cardiovascular quality and outcomes2009
Comparing methods of measuring treatment intensification in hypertension care.
Article in Circulation. Cardiovascular quality and outcomes, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- Evidence for Age Bias Contributing to Therapeutic Inertia in Blood Pressure Management: A Secondary Analysis of SPRINT.Hypertension (Dallas, Tex. : 1979) · 2023Trial
- Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction.Journal of the American Society of Hypertension : JASH · 2016Trial
- Randomized trial protocol for remote monitoring for equity in advancing the control of hypertension in safety net systems (REACH-SNS) study.Contemporary clinical trials · 2023Article
- Tracking Blood Pressure Control Performance and Process Metrics in 25 US Health Systems: The PCORnet Blood Pressure Control Laboratory.Journal of the American Heart Association · 2021Article
- Treatment Intensification for Elevated Blood Pressure and Risk of Recurrent Stroke.Journal of the American Heart Association · 2021Observational
- Race-Specific Patterns of Treatment Intensification Among Hypertensive Patients Using Home Blood Pressure Monitoring: Analysis Using Defined Daily Doses in the Heart Healthy Lenoir Study.The Annals of pharmacotherapy · 2019Article
- Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial.JMIR research protocols · 2019Article
- Clinical inertia and the 2017 ACA/AHA guideline.Journal of clinical hypertension (Greenwich, Conn.) · 2018Article
- Associations of Four Community Factors With Longitudinal Change in Hemoglobin ADiabetes care · 2018Article
- Therapeutic Inertia and Treatment Intensification.Current hypertension reports · 2018Review
- Understanding Uncontrolled Hypertension.Journal of clinical hypertension (Greenwich, Conn.) · 2016Article
- Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure.Stroke · 2015Article
- An investigation of associations between clinicians' ethnic or racial bias and hypertension treatment, medication adherence and blood pressure control.Journal of general internal medicine · 2014Article
- Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?PloS one · 2013Article
- The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension.Hypertension (Dallas, Tex. : 1979) · 2012Article
- Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions.Psychosomatic medicine · 2011Review
- Understanding racial disparities in treatment intensification for hypertension management.Journal of general internal medicine · 2010Article
- Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients.Circulation. Cardiovascular quality and outcomes · 2010Article
- Intensifying therapy for hypertension despite suboptimal adherence.Hypertension (Dallas, Tex. : 1979) · 2009Article
- Gender differences in cardiovascular risk factors in incident diabetes.Women's health issues : official publication of the Jacobs Institute of Women's HealthArticle
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundGreater treatment intensification (TI) improves hypertension control. However, we do not know the ideal way to measure TI for research and quality improvement efforts. We compared the ability of different TI measures to predict blood pressure (BP) control. METHODS AND
resultsWe enrolled 819 hypertensive outpatients from an urban academic hospital. Each patient was assigned 3 scores to characterize TI. The any/none score divides patients into those who had any therapy increases during the study versus none. The norm-based method models the chance of a medication increase at each visit, then scores each patient based on whether they received more or fewer medication increases than predicted. The standard-based method is similar to the norm-based method but expects a medication increase whenever the blood pressure is uncontrolled. We compared the ability of these scores to predict the final systolic blood pressure (SBP). The any/none score showed a paradoxical result: any therapy increase was associated with SBP 4.6 mm Hg higher than no increase (P<0.001). The norm-based method score did not predict SBP in a linear fashion (P=0.18); further investigation revealed a U-shaped relationship between the norm-based method score and SBP. However, the standard-based method score was a strong linear predictor of SBP (2.1 mm Hg lower for each additional therapy increase per 10 visits, P<0.001). Similarly, the standard-based method predicted dichotomized blood pressure control, as measured by SBP <140 mm Hg (odds ratio, 1.30; P<0.001).
conclusionsOur results suggest that standard-based method is the preferred measure of treatment intensity for hypertension care.
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