title: Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients.
abstract: BACKGROUND
  Blood pressure (BP) control among coronary artery disease patients remains suboptimal in clinical practice, potentially due to gaps in treatment intensification and medication adherence. However, longitudinal studies evaluating these relationships and outcomes are limited.
  
  
  RESULTS
  We assessed BP trajectories among health maintenance organization patients with hypertension and incident coronary artery disease. BP trajectories were modeled over the year after coronary artery disease diagnosis, stratified by target BP goal. Treatment intensification (increase in BP therapies in the setting of an elevated BP), medication adherence (percentage of days covered with BP therapies), and outcomes (all-cause mortality, myocardial infarction, and revascularization) were evaluated in multivariable models: 9569 patients had a <140/90 mm Hg BP target and 12,861 had a <130/80 mm Hg BP target. Within each group, 4 trajectories were identified: good, borderline, improved, and poor control. After adjustment, increasing BP treatment intensity was significantly associated with better BP trajectories in both groups. Medication adherence had inconsistent effects. There were no significant differences in combined outcomes by BP trajectory, but among the diabetes and renal disease cohort, borderline control patients were less likely to have myocardial infarction (odds ratio, 0.61; 95% confidence interval, 0.40-0.93), and good control patients were less likely to have myocardial infarction (odds ratio, 0.53; 95% confidence interval, 0.34-0.84) or a revascularization procedure (odds ratio, 0.66; 95% confidence interval, 0.47-0.93) compared with poor control patients.
  
  
  CONCLUSIONS
  In this health maintenance organization population, treatment intensification but not medication adherence significantly affects BP trajectories in the year after coronary artery disease diagnosis. Better BP trajectories are associated with lower rates of myocardial infarction and revascularization.
authors.affiliation: Cardiology Section, Denver VAMC/University of Colorado Denver, Denver, CO 80220, USA. thomas.maddox@va.gov
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.forename: Colleen
authors.initials: C
authors.lastname: Ross
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tavel
authors.forename: Ella E
authors.initials: EE
authors.lastname: Lyons
authors.forename: Maggie
authors.initials: M
authors.lastname: Tillquist
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D002985:Clinical Protocols; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D000959:Antihypertensive Agents