title: Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management.
abstract: Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (-6.4 mm Hg [95% confidence interval, -12.2 to -0.6]) and near significant at 18 months (-6.0 mm Hg [95% confidence interval, -12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.|Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University, Durham, NC.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Crowley
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.|Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Woolson
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC.
authors.forename: Heather A
authors.initials: HA
authors.lastname: King
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC.
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D000959:Antihypertensive Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D019468:Disease Management; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents