Rapid adjustment of antihypertensive drugs produces a durable improvement in blood pressure

Antihypertensive drugs are often initiated and adjusted over a period of weeks to months. It is not clear whether the time and inconvenience of this approach is necessary. We studied whether or not drug adjustment over several days in the context of a physician–nurse team could produce a durable blood pressure benefit according to home blood pressure measurements. Sixty-eight patients (aged 65 ± 1 years, 47% men) were referred for management of hypertension. Indications for referral were new hypertension (13%), known/controlled hypertension (30%), or known/uncontrolled hypertension (57%). Patients had one to three brief nurse visits/day and were provided with an accurate semiautomated device for self-blood pressure (BP) measurement. Sixty patients provided follow-up data. Group 1 ( n = 16) required no change in their preexisting drug regimen during clinic visits, whereas group 2 ( n = 44) had drug therapy initiated or adjusted over 4 ± 1 days. Patients were evaluated at baseline, at dismissal from the clinic, and at latest follow-up (mailed-in report of 42 readings taken over 7 days at 1- to 3-month intervals). Mean follow-up was 11 ± 0.5 months. Mean BP at baseline, dismissal, and latest follow-up for group 1 were 132 ± 4/73 ± 2, 130 ± 6/70 ± 2, and 125 ± 3/73 ± 3 mm Hg ( P = not significant). Mean BP for group 2 at the same intervals were 150 ± 4/80 ± 2, 139 ± 3 ( P < .01 v baseline)/75 ± 2, 133 ± 2 ( P < .01 v baseline and < .05 v dismissal)/74 ± 1 ( P < .01 v baseline). The BP control rate (blood pressures less than 140/90 mm Hg) was 75% in group 2. Drug number/dose remained the same or lower in 87% and 91% of patients during follow-up in groups 1 and 2, respectively. These results suggest that a clinically significant lowering of blood pressure can often be achieved over several days and maintained for up to 1 year. Increased use of rapid drug titration, a physician–nurse team approach, and self-BP measurement at prescribed intervals have the potential to improve BP control rates and reduce the expense and inconvenience associated with the treatment of hypertension.