Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management

Nelson Wang; Katie Harris; Mark Woodward; Stephen Harrap; Giuseppe Mancia; Neil Poulter; John Chalmers; Anthony Rodgers; on behalf of the PROGRESS and ADVANCE collaborators

doi:10.1161/HYPERTENSIONAHA.122.20458

Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management

Nelson Wang, Katie Harris, Mark Woodward, Stephen Harrap, Giuseppe Mancia, Neil Poulter, John Chalmers, Anthony Rodgers, on behalf of the PROGRESS and ADVANCE collaborators

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Background: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response.

Methods: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes).

Results: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1).

Conclusions: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00145925.

Original language	English
Pages (from-to)	608-617
Number of pages	10
Journal	Hypertension
Volume	80
Issue number	3
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.122.20458
Publication status	Published - Mar 2023
Externally published	Yes

Keywords

blood pressure
clinical trial
hypertension
office blood pressure

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@article{52472583dc324f5db8a865eb677b47da,

title = "Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management",

abstract = "Background: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response. Methods: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes). Results: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1). Conclusions: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00145925.",

keywords = "blood pressure, clinical trial, hypertension, office blood pressure",

author = "Nelson Wang and Katie Harris and Mark Woodward and Stephen Harrap and Giuseppe Mancia and Neil Poulter and John Chalmers and Anthony Rodgers and {on behalf of the PROGRESS and ADVANCE collaborators}",

year = "2023",

month = mar,

doi = "10.1161/HYPERTENSIONAHA.122.20458",

language = "English",

volume = "80",

pages = "608--617",

journal = "Hypertension",

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publisher = "Lippincott Williams & Wilkins",

number = "3",

}

TY - JOUR

T1 - Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management

AU - Wang, Nelson

AU - Harris, Katie

AU - Woodward, Mark

AU - Harrap, Stephen

AU - Mancia, Giuseppe

AU - Poulter, Neil

AU - Chalmers, John

AU - Rodgers, Anthony

AU - on behalf of the PROGRESS and ADVANCE collaborators

PY - 2023/3

Y1 - 2023/3

N2 - Background: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response. Methods: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes). Results: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1). Conclusions: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00145925.

AB - Background: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response. Methods: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes). Results: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1). Conclusions: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00145925.

KW - blood pressure

KW - clinical trial

KW - hypertension

KW - office blood pressure

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UR - http://purl.org/au-research/grants/NHMRC/1149987

U2 - 10.1161/HYPERTENSIONAHA.122.20458

DO - 10.1161/HYPERTENSIONAHA.122.20458

M3 - Article

SN - 0194-911X

VL - 80

SP - 608

EP - 617

JO - Hypertension

JF - Hypertension

IS - 3

ER -

Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management

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