From stubborn high blood pressure to diverticulitis, two deputy editors of the Annals of Internal Medicine reviewed eight recently published articles they feel will influence practice.
1. Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults: A Retrospective Observational Study
Roughly 1 in 3 adults with hypertension have inadequate blood pressure control, and clinicians have two options for intensifying treatment: "The dose of the current drug regimen can be maximized, or a new drug can be added," said Deputy Editor Christina C. Wee, MD, MPH.
Data from randomized controlled trials suggest treatment with lower doses of combination therapy may be more effective, with fewer side effects — although the best strategy in older adults remains unclear.
To answer that question, researchers conducted a large-scale, population-based, retrospective cohort study, and observational data were used to emulate a target trial with two groups: new medication and maximizing dose.
The cohort comprised people aged 65 years or older with hypertension and was limited to those with a systolic blood pressure of 130 mm Hg or higher. Two intensification approaches were used: (1) adding a new medication, defined as a total dose increase with a new medication; and (2) maximizing dose, defined as a total dose increase without new medication.
A total of 178,562 patients were included in the study, and 45,575 (25.5%) had intensification by adding a new medication and 132,987 (74.5%) by maximizing dose.
