Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults
Authors: Carole E. Aubert, Jeremy B. Sussman, Timothy P. Hofer, William C. Cushman, Jin-Kyung Ha, Lillian Min
Journal: Annals of Internal Medicine (2022)

LettersFebruary 2022Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older AdultsCarole E. Aubert, MD, MSc, Jeremy B. Sussman, MD, MS, Timothy P. Hofer, MD, MSc, William C. Cushman, MD, Jin-Kyung Ha, PhD, Lillian Min, MD, MSHSCarole E. Aubert, MD, MScCenter for Clinical Management Research at Veterans Affairs Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at University of Michigan, Ann Arbor, Michigan, and Inselspital, Bern University Hospital and Institute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandSearch for more papers by this author, Jeremy B. Sussman, MD, MSCenter for Clinical Management Research at Veterans Affairs Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at University of Michigan, Ann Arbor, MichiganSearch for more papers by this author, Timothy P. Hofer, MD, MScCenter for Clinical Management Research at Veterans Affairs Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at University of Michigan, Ann Arbor, MichiganSearch for more papers by this author, William C. Cushman, MDUniversity of Tennessee Health Science Center, Memphis, TennesseeSearch for more papers by this author, Jin-Kyung Ha, PhDVeterans Affairs Ann Arbor Medical Center Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MichiganSearch for more papers by this author, Lillian Min, MD, MSHSCenter for Clinical Management Research, Institute for Healthcare Policy and Innovation, University of Michigan, and Veterans Affairs Ann Arbor Medical Center Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MichiganSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0749 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We agree with Dr. Fujikawa that out-of-office BP measurements, such as home and 24-hour ambulatory measurements, should be incorporated into the care of older adults to confirm borderline cases of hypertension, avoid treating white coat hypertension, and monitor treatment (1, 2). However, those measurements were not available in our data set. In response to Dr. Fujikawa's question about the definition of follow-up BP measurements, we confirm that our measurements were collected from ambulatory clinic visits to primary and specialty care that manage hypertension.We agree that use of multiple BP measurements provides more precise estimates. We thus used ...References1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-248. [PMID: 29146535] doi:10.1016/j.jacc.2017.11.006 CrossrefMedlineGoogle Scholar2. Muntner P, Carey RM, Jamerson K, et al. Rationale for ambulatory and home blood pressure monitoring thresholds in the 2017 American College of Cardiology/American Heart Association guideline [Editorial]. Hypertension. 2019;73:33-8. [PMID: 30571569] doi:10.1161/HYPERTENSIONAHA.118.11946 CrossrefMedlineGoogle Scholar3. Llabre MM, Ironson GH, Spitzer SB, et al. How many blood pressure measurements are enough? An application of generalizability theory to the study of blood pressure reliability. Psychophysiology. 1988;25:97-106. [PMID: 3353490] CrossrefMedlineGoogle Scholar4. Verberk WJ, Kroon AA, Kessels AG, et al. The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings. J Hypertens. 2006;24:1541-8. [PMID: 16877956] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Center for Clinical Management Research at Veterans Affairs Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at University of Michigan, Ann Arbor, Michigan, and Inselspital, Bern University Hospital and Institute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandCenter for Clinical Management Research at Veterans Affairs Ann Arbor Healthcare System and Institute for Healthcare Policy and Innovation at University of Michigan, Ann Arbor, MichiganUniversity of Tennessee Health Science Center, Memphis, TennesseeVeterans Affairs Ann Arbor Medical Center Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MichiganCenter for Clinical Management Research, Institute for Healthcare Policy and Innovation, University of Michigan, and Veterans Affairs Ann Arbor Medical Center Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MichiganDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-1456. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAdding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults Carole E. Aubert , Jeremy B. Sussman , Timothy P. Hofer , William C. Cushman , Jin-Kyung Ha , and Lillian Min Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults Tatsuya Fujikawa Metrics February 2022Volume 175, Issue 2Page: W15-W16KeywordsElderlyGeriatric careHealth careHospital medicineHypertensionPreventive medicineTreatment guidelinesVeteran care ePublished: 15 February 2022 Issue Published: February 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...