title: Cardiac risk is not associated with hypertension treatment intensification.
abstract: Considering cardiovascular (CV) risk could make clinical care more efficient and individualized, but most practice guidelines focus on single risk factors. We sought to determine if hypertension treatment intensification (TI) is more likely in patients with elevated CV risk.
  
  
  
  Prospective cohort study of 856 US veterans with diabetes and elevated blood pressure (BP).
  
  
  
  We used multilevel logistic regression to compare TI across 3 CV risk groups: those with history of heart disease, a high-risk primary prevention group (10-year event risk >20% but no history of heart disease), and those with low/ medium CV risk (10-year event risk <20%).
  
  
  
  There were no significant differences in TI rates across risk groups, with adjusted odds ratios (ORs) of 1.19 (95% confidence interval 0.77-1.84) and 1.18 (0.76-1.83) for high-risk patients and those with a history of CVD, respectively, compared with those of low/medium risk. Several individual risk factors were associated with higher rates of TI: systolic BP, mean BP in the prior year, and higher glycated hemoglobin. Self-reported home BP <140/90 mm Hg was associated with lower rates of TI. Incorporating CV risk into TI decision algorithms could prevent an estimated 38% more cardiac events without increasing the number of treated patients.
  
  
  
  While an individual's BP alters clinical decisions about TI, overall CV risk does not appear to play a role in clinical decision making. Adoption of TI decision algorithms that incorporate CV risk could substantially enhance the efficiency and clinical utility of CV preventive care.
authors.affiliation: Veterans Affairs Center for Clinical Management Research, HSR&D Center of Excellence, Ann Harbor, MI, USA. jeremysu@med.umich.edu
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Sussman
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
authors.forename: Rodney
authors.initials: R
authors.lastname: Hayward
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hofer
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D003657:Decision Making; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008875:Middle Aged; D015146:Midwestern United States; D011446:Prospective Studies; D018570:Risk Assessment; D014728:Veterans
chemical_list: D000959:Antihypertensive Agents