Treatment Intensification and Medication Adherence Are Factors in Improving Blood Pressure Trajectories among Newly Diagnosed CAD Patients

Background: Blood pressure (BP) control among coronary artery disease (CAD) patients is sub-optimal in clinical practice and may be due to gaps in treatment intensification and medication adherence. However, longitudinal studies evaluating these relationships are limited. Methods: We assessed BP trajectories among managed care patients with hypertension and incident CAD. Patients were stratified by target BP goal (<140/90 or <130/80 among those with diabetes or renal disease) and BP trajectories were modeled over the year following CAD diagnosis. Treatment intensification (increase in BP therapies in the setting of an elevated BP) and medication adherence (percentage of days covered with BP therapies) were evaluated in multivariable models adjusting for patient variables. Results: 2763 patients had a <140/90 BP goal and 9890 had a <130/80 BP goal. Within each BP goal group, four trajectories were identified - persistently uncontrolled (Group 1), uncontrolled to controlled (Group 2), controlled to uncontrolled (Group 3), and persistently controlled (Group 4). In multivariable models comparing Group 2 to Group 1, treatment intensification was associated with improved BP control over the year for both groups (OR for <140/90 BP goal 0.75, 95% CI 0.66, 0.84; OR for <130/80 BP goal 0.93, 95% CI 0.89, 0.98). Medication adherence was associated with improved BP control among the 130/80 target BP group only (OR for <140/90 BP goal 0.79, 95% CI 0.38, 1.69; OR for <130/80 BP goal 0.66, 95% CI 0.49, 0.9). Conclusions: In this managed care patient population, treatment intensification and medication adherence significantly affect BP trajectories in the year following CAD diagnosis.