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Rapid treatment of moderate to severe hypertension using a novel protocol in a single-centre, before and after interventional study

Journal of Human Hypertension volume 34, pages 165–175 (2020)Cite this article

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Abstract

Rapid treatment to target in hypertension may have beneficial effects on long-term outcomes. This has led to a new recommendation in the 2018 European hypertension guidelines for patients with grade II/III hypertension to be treated to target within three months. However, whether it is feasible and safe to quickly manage treatment-naïve grade II/III hypertension to target was unclear. We examined this using a single-centre before and after interventional study, treating newly diagnosed, never-treated, grade II/III hypertensive patients with a daytime average systolic ABP ≥ 150 mmHg to target within 18 weeks. The proportion at office target BP at 18 weeks was determined, together with office and ambulatory BP change from baseline to after the intervention. The protocol was designed to maximise medication adherence, including a low threshold for treatment adaptation. Safety was evaluated through close monitoring of adverse events and protocol discontinuation. Fifty-five participants were enrolled with 54 completing the protocol. 69 ± 12.3% were at office target BP at their final visit, despite a high average starting BP of 175/103 mmHg, as a consequence of significant reductions in both office and ambulatory BP. Of those at office target BP, 51% were above target on ambulatory measurement. Adherence testing demonstrated that 92% of participants were adherent to treatment at their final visit. Therefore we conclude that the accelerated management of treatment-naïve grade II/III hypertension is feasible and safe to implement in routine practice and there is no evidence to suggest it causes harm. Further large-scale randomised studies of rapid, adaptive treatment, including a cost-effectiveness analysis, are required.

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Acknowledgements

The study was supported by the NIHR Exeter Clinical Research Facility. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The study team would also like to thank Mr. David Mawson, Dr. Kim Gooding and all the nursing staff at Vascular Medicine, NIHR Exeter Clinical Research Centre, Exeter, for their invaluable help in supporting the study.

Funding

Funding for this study was provided by the Gawthorn Cardiac Trust (Charity no. 1005192). CEC was funded by an NIHR Clinical Lectureship award.

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Authors and Affiliations

  1. NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK

    Andrew N. Jordan, Christine Anning, Lindsay Wilkes, Claire Ball, Nicola Pamphilon & Angela C. Shore

  2. Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK

    Andrew N. Jordan, Nicholas G. Bellenger, Angela C. Shore & Andrew S. P. Sharp

  3. Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Magdalen Road, Exeter, EX1 2 LU, UK

    Christopher E. Clark

  4. Department of Cardiology, Royal Devon and Exeter Hospital, Exeter and University Hospital of Wales, Cardiff, UK

    Nicholas G. Bellenger & Andrew S. P. Sharp

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  1. Andrew N. Jordan
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Correspondence to Andrew S. P. Sharp.

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Presented in part at the BIHS Annual Meeting 2018.

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Jordan, A.N., Anning, C., Wilkes, L. et al. Rapid treatment of moderate to severe hypertension using a novel protocol in a single-centre, before and after interventional study. J Hum Hypertens 34, 165–175 (2020). https://doi.org/10.1038/s41371-019-0272-1

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