A sizable proportion of outpatient cardiovascular patients in the U.S. have not achieved guideline-directed blood pressure (BP) goals, even though prescriptions for antihypertensive medications have increased over time, according to recent study published in The Journal of Clinical Hypertension.

Using data from the Veradigm Cardiology Registry (formerly the NCDR PINNACLE Registry), Eric J. Brandt, MD, FACC, et al., examined trends in BP goal achievement at outpatient cardiology practices in relation to the timing of the release of the Joint National Committee (JNC)-8 recommendations (October 2014), publication of the SPRINT trial results (November 2015) and the release of the ACC/American Heart Association (AHA) hypertension guideline (November 2017). Their analysis included 3,678,774 individuals (≥65 years) with hypertension from 2013 to 2018.

One of the study's primary outcomes was the proportion of patients achieving systolic BP (SBP) goals (<140 and <130 mm Hg) and diastolic BP (DBP) goals (<90 and <80 mm Hg). Results showed a small but significant increase in the proportion of patients achieving SBP <140 mm Hg from 67% (95% CI, 66%-68%) to 70% (95% CI, 70%-71%). No significant changes were identified in achieving SBP <130 mm Hg or either DBP goals.

Another primary outcome was the proportion of patients prescribed antihypertensive medication. This measure increased from 33% (95% CI, 32%-35%) at the start of the study period to 40% (95% CI, 39%-41%) by 2018. Similar results were found when looking at trends for specific medication classes, including diuretics, calcium channel blockers, beta-blockers, and ARB/ACE inhibitors.

The authors also note increasing practice-level variation over time in achieving SBP <140 mm Hg (median odds ratio 1.46 pre-JNC-8 vs. 1.58 post ACC/AHA guideline; p=0.016). "This may be from differences in barriers to care, BP measurement methods, and patient complexity," they write. "Further data are needed to explore the etiology for these differences and improve guideline implementation."