Decisions about treatment of cardiovascular risk factors are often made in a way that can limit the effectiveness of chosen therapies. Often clinical decision-making is based on treating individual risk factors, rather than considering a more powerful predictor of future cardiac events—overall cardiovascular disease risk.
In a recent article, Sussman et al describe the findings of a study assessing whether clinicians took overall cardiovascular disease risk into account when making treatment decisions about intensifying hypertension treatment in those with elevated blood pressure.1 They also analyzed whether patients’ individual risk factors were associated with the therapy or medications prescribed by clinicians.
The Addressing Barriers to Treatment for Hypertension prospective cohort study examined various factors that influenced providers’ decisions about blood pressure management. The study included 856 veterans with diabetes and hypertension, who were treated by clinicians from nine Veterans Health Administration (VHA) facilities in three Midwestern states.
For each patient, the researchers assessed whether a clinician intensified blood pressure therapy within three months of the first visit for hypertension. The authors defined intensification of treatment as an increased dosage for a hypertension medication or starting a new therapy medication or switching to an alternative. Data was obtained from surveys of providers and patients after each clinical visit, electronic medical record review, and data from VHA databases.
Aside from overall cardiovascular risk, the researchers examined other factors that might influence treatment decisions, such as comorbidities and number of medications, and clinical uncertainty about home measurements of blood pressure. They also considered whether clinicians might consider blood pressure treatment to be of uncertain benefit due to previous use of several different blood pressure medications.