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At the heart of general practice since 1960

Delay in increasing antihypertensive dose 'raises mortality'

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The study

The evidence for ideal time intervals between measuring BP and medication changes or dose increases of antihypertensives is unknown.

So a retrospective cohort analysis of around 88, 000 patients between 1986 and 2010 in Britain aimed to find out if the time taken to increase dose or change anti-hypertensive medications (for people with elevated blood pressure), and the time-interval to follow up patients after that, has any association with cardiovascular events or mortality.

The findings

There is an increased risk of death from the following:

1 A delay of more than 1.4 months in increasing the dose of anti-hypertensives in patients with raised blood pressure.

2 A delay of more than 2.7 months in follow-up after increasing the dose of hypertensives.

What does it mean for GPs?

Delays should be minimised in dose-increases or medication changes for patients with elevated blood pressure.

After medication changes and dose-increases, patients should be followed up as soon as possible.

The paper

BMJ February 2015

Dr Hamed Khan is a GP in the emergency department of St George’s, London and a clinical lecturer. He tweets as @drhamedkhan.

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