Treatment Initiation During The First Month Following Hypertension Diagnosis Improves Blood Pressure Control Up To 30 Months

Background: Adults with hypertension (HTN) have fewer cardiovascular events if controlled within the first 6 months after diagnosis, during which time they are excluded from many HTN control metrics. We compared BP control rates (BP <140/90) from 6 to 42 months in adults with HTN who did or did not have treatment initiated during the first month following diagnosis, irrespective of subsequent treatment initiation or intensification (TI). Methods: A patient cohort from 5 diverse healthcare organizations, engaged in a quality improvement program, was identified with previously undiagnosed and untreated HTN. TI and BP control were assessed by measuring the period prevalence of visit BP control and TI on uncontrolled visits, then compared with the time since diagnosis (TSD) up to 42 months. Groups were stratified by treatment initiation status during the first month. Results: A prospective cohort of 14,328 newly diagnosed and untreated persons with HTN was identified, mean age 56.2±14.7 years. Patients with TI during the first month had higher rates of BP control at 6 (56.2% vs 46.2%, p<0.001) through 30 months (65.9% vs 61.4%, p<0.001) than those initially untreated. Patients initiated during the first month were less likely to receive additional intensifications (OR 0.68, 95% CI [0.63-0.74]). Conclusion: TI in the first month after diagnosis results in better BP control at 6 months, which has prognostic importance and coincides with the time when these individuals impact standard HTN control metrics. Of concern, TI during the first month after diagnosis was insufficient to achieve control rates ≥70% and lowered the probability of subsequent TI.