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Controlling Hypertension in Older Adults: Up Dose or Add New Med?

Bigger drop in systolic BP but less intensification sustainability seen with addition of new med versus maximizing dose of current med

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TUESDAY, Oct. 5, 2021 (HealthDay News) -- For older adults with hypertension receiving at least one antihypertensive medication at less than the maximum dose, intensification with the addition of a new medication is associated with less intensification sustainability and a slightly larger reduction in mean systolic blood pressure (SBP) than maximizing the dose, according to a study published online Oct. 5 in the Annals of Internal Medicine.

Carole E. Aubert, M.D., from Bern University Hospital in Switzerland, and colleagues examined the frequency of intensification by adding a new medication versus maximizing the dose in a large-scale, population-based retrospective cohort study. Data were included for veterans aged 65 years or older with hypertension, SBP of at least 130 mm Hg, and at least one antihypertensive medication at less than the maximum dose. Among 178,562 patients, 25.5 and 74.5 percent had intensification by adding a new medication and maximizing the dose, respectively.

The researchers found that at three months and 12 months, adding a new medication was associated with less intensification sustainability (average treatment effect, −15.2 and −15.1 percent, respectively) and a larger reduction in mean SBP (−0.8 and −1.1 mm Hg, respectively) compared with maximizing the dose.

"Adding a new medication was associated with greater SBP reduction but less frequent sustained intensification, possibly suggesting that adverse drug events might be more common or patients less willing to take additional medications," the authors write.

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