How quickly should we titrate antihypertensive medication? Systematic review modelling blood pressure response from trial data

Daniel S. Lasserson, Thierry Buclin, Paul Glasziou

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Context: There are no evidence syntheses available to guide clinicians on when to titrate antihypertensive medication after initiation. Objective: To model the blood pressure (BP) response after initiating antihypertensive medication. Data sources electronic databases including Medline, Embase, Cochrane Register and reference lists up to December 2009. Study selection: Trials that initiated antihypertensive medication as single therapy in hypertensive patients who were either drug naive or had a placebo washout from previous drugs. Data extraction: Office BP measurements at a minimum of two weekly intervals for a minimum of 4 weeks. An asymptotic approach model of BP response was assumed and non-linear mixed effects modelling used to calculate model parameters. Results and conclusions: Eighteen trials that recruited 4168 patients met inclusion criteria. The time to reach 50% of the maximum estimated BP lowering effect was 1 week (systolic 0.91 weeks, 95% CI 0.74 to 1.10; diastolic 0.95, 0.75 to 1.15). Models incorporating drug class as a source of variability did not improve fit of the data. Incorporating the presence of a titration schedule improved model fit for both systolic and diastolic pressure. Titration increased both the predicted maximum effect and the time taken to reach 50% of the maximum (systolic 1.2 vs 0.7 weeks; diastolic 1.4 vs 0.7 weeks). Conclusions: Estimates of the maximum efficacy of antihypertensive agents can be made early after starting therapy. This knowledge will guide clinicians in deciding when a newly started antihypertensive agent is likely to be effective or not at controlling BP.

Original languageEnglish
Pages (from-to)1771-1775
Number of pages5
JournalHeart
Volume97
Issue number21
DOIs
Publication statusPublished - Nov 2011

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Antihypertensive Agents
Blood Pressure
Pharmaceutical Preparations
Information Storage and Retrieval
Appointments and Schedules
Placebos
Databases
Therapeutics

Cite this

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title = "How quickly should we titrate antihypertensive medication? Systematic review modelling blood pressure response from trial data",
abstract = "Context: There are no evidence syntheses available to guide clinicians on when to titrate antihypertensive medication after initiation. Objective: To model the blood pressure (BP) response after initiating antihypertensive medication. Data sources electronic databases including Medline, Embase, Cochrane Register and reference lists up to December 2009. Study selection: Trials that initiated antihypertensive medication as single therapy in hypertensive patients who were either drug naive or had a placebo washout from previous drugs. Data extraction: Office BP measurements at a minimum of two weekly intervals for a minimum of 4 weeks. An asymptotic approach model of BP response was assumed and non-linear mixed effects modelling used to calculate model parameters. Results and conclusions: Eighteen trials that recruited 4168 patients met inclusion criteria. The time to reach 50{\%} of the maximum estimated BP lowering effect was 1 week (systolic 0.91 weeks, 95{\%} CI 0.74 to 1.10; diastolic 0.95, 0.75 to 1.15). Models incorporating drug class as a source of variability did not improve fit of the data. Incorporating the presence of a titration schedule improved model fit for both systolic and diastolic pressure. Titration increased both the predicted maximum effect and the time taken to reach 50{\%} of the maximum (systolic 1.2 vs 0.7 weeks; diastolic 1.4 vs 0.7 weeks). Conclusions: Estimates of the maximum efficacy of antihypertensive agents can be made early after starting therapy. This knowledge will guide clinicians in deciding when a newly started antihypertensive agent is likely to be effective or not at controlling BP.",
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How quickly should we titrate antihypertensive medication? Systematic review modelling blood pressure response from trial data. / Lasserson, Daniel S.; Buclin, Thierry; Glasziou, Paul.

In: Heart, Vol. 97, No. 21, 11.2011, p. 1771-1775.

Research output: Contribution to journalArticleResearchpeer-review

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