Antihypertensive Augmentation: Maximize Dose or Add a New Med?

In drug-treated patients with hypertension whose blood pressure (BP) is inadequately controlled, augmentation strategies include maximizing the dose of a currently prescribed antihypertensive medication or adding another antihypertensive drug. In a retrospective cohort study, investigators identified 487,000 older hypertensive U.S. veterans (age, ≥65; 98% men) whose mean systolic BP during two recent visits was >130 mm Hg. In 178,000 of these patients, clinicians intensified drug treatment: In 25%, a new antihypertensive medication was added, and in 75%, the dose of a currently prescribed antihypertensive medication was maximized.

Compared with maximizing medication dose, adding a new medication was associated with significantly less adheren…