Using central, rather than brachial, blood pressure (BP) to guide treatment decisions results in patients with hypertension being given less medication, show results from a randomized trial.
The reduced level of medication was achieved over 1 year without adverse effects on left ventricular (LV) mass, aortic stiffness, or quality of life, report James Sharman (University of Tasmania, Hobart, Australia) and co-workers.
“Together, these data establish proof of concept that measurement of central BP could be clinically advantageous in treatment of lower- to medium-risk patients with hypertension,” they write in Hypertension.
The 286 patients in the study were assessed every 3 months, and therapeutic decisions were made centrally, by the investigators, and relayed to the treating physicians. The physicians complied with the titration recommendations in 92% of instances, with contrary decisions often based on changes in clinical presentation or in the patients’ circumstances.
During the 1-year study, the daily defined dose (DDD) of antihypertensive medication remained stable in patients randomly assigned to have treatment decisions based on usual best-practice care. But the DDD fell at each assessment point in patients assigned to have central BP measured in addition to usual care.
At 12 months, 15% of patients in the central BP group had a medication reduction, compared with 3% of the usual care group, while 16% versus 2% had their medication stopped.
“Our data demonstrate that paying attention to central BP can result in therapeutic decisions that are substantially different from best-practice usual care where only brachial BP is considered,” say Sharman et al.
LV mass did not increase in the central BP group, despite the reduction of therapy. In fact, there was a slight, nonsignificant decrease, while the usual care group had a slight, nonsignificant increase, leading to a borderline significant difference between the groups (p=0.079).
The researchers say this finding “was unexpected and merits further investigation because this could be a clue toward helping to understand why intensive BP lowering may increase risk in some patients.”
There was no difference in changes in aortic stiffness or quality of life between the two groups, and average 24-hour ambulatory blood pressure remained stable.
Sharman and team suggest that “central BP monitoring may be especially valuable in patient populations where there may be a risk of promoting harmful outcomes by pursuing low BP targets, such as in the elderly where fall risk may be increased.”
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