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Impact of therapeutic inertia on long-term blood pressure control a Monte Carlo simulation study

Impact of therapeutic inertia on long-term blood pressure control a Monte Carlo simulation study
Impact of therapeutic inertia on long-term blood pressure control a Monte Carlo simulation study
Antihypertensive drug treatment is based on stepped titration in response to elevated blood pressure (BP) measurements. However, measurements do not necessarily represent an individual’s true BP (due to random error and biological variability), and medications are not always increased when measurements are above target (therapeutic inertia). We developed a Monte Carlo model with a 10-year horizon to investigate how measurement error impacted systolic BP (SBP) control in the presence of therapeutic inertia. When SBP measurements were in the range 140 to 159 mm Hg, the probability of escalating treatment was determined by a Bernoulli probability mass function parameterized by weighting functions exploring distinct inertia profiles. Simulating inertia with the weighting function that approximated to clinical practice resulted in ≈50% of individuals failing to achieve their SBP target within the 10-year time horizon. An inverse relationship was observed between measurement error and SBP control. This suggests that the value of accurate SBP measurement is only realized if it changes the underlying probability of inertia—that is, patients/clinicians believe a measurement to be accurate and so are more likely to act upon it. Removal of inertia during treatment initiation (ie, stepped titration until SBP measurement was below target) improved true SBP control for all simulations. Our simulations show that the impact of therapeutic inertia during treatment initiation persists during long-term follow-up. Strategies to remove therapeutic inertia during treatment initiation (ie, dual antihypertensive therapy) are likely to improve long-term BP control irrespective of BP measurement technique.
antihypertensive agents, blood pressure, hypertension, uncertainty
0194-911X
1350–1359
Augustin, Alexandry
9b708f1d-c361-4b3d-ac30-0d08e8bf5499
Coutts, Louise
90c9e532-5400-4ef8-853f-0e3c311b4f27
Zanisi, Lorenzo
87405729-1792-4919-a0de-fc92ea450edb
Wierzbicki, Anthony S.
5874b91d-654a-40b5-a5ec-8bf0b80b1a57
Shankar, Francesco
b10c91e4-85cd-4394-a18a-d4f049fd9cdb
Chowienczyk, Phil J.
78a000ab-d8ac-4928-a233-a85aedf00183
Floyd, Christopher N.
f938699a-76b5-4bbb-89b0-4f57fd5eda4f
Augustin, Alexandry
9b708f1d-c361-4b3d-ac30-0d08e8bf5499
Coutts, Louise
90c9e532-5400-4ef8-853f-0e3c311b4f27
Zanisi, Lorenzo
87405729-1792-4919-a0de-fc92ea450edb
Wierzbicki, Anthony S.
5874b91d-654a-40b5-a5ec-8bf0b80b1a57
Shankar, Francesco
b10c91e4-85cd-4394-a18a-d4f049fd9cdb
Chowienczyk, Phil J.
78a000ab-d8ac-4928-a233-a85aedf00183
Floyd, Christopher N.
f938699a-76b5-4bbb-89b0-4f57fd5eda4f

Augustin, Alexandry, Coutts, Louise, Zanisi, Lorenzo, Wierzbicki, Anthony S., Shankar, Francesco, Chowienczyk, Phil J. and Floyd, Christopher N. (2021) Impact of therapeutic inertia on long-term blood pressure control a Monte Carlo simulation study. Hypertension, 77 (4), 1350–1359. (doi:10.1161/HYPERTENSIONAHA.120.15866).

Record type: Article

Abstract

Antihypertensive drug treatment is based on stepped titration in response to elevated blood pressure (BP) measurements. However, measurements do not necessarily represent an individual’s true BP (due to random error and biological variability), and medications are not always increased when measurements are above target (therapeutic inertia). We developed a Monte Carlo model with a 10-year horizon to investigate how measurement error impacted systolic BP (SBP) control in the presence of therapeutic inertia. When SBP measurements were in the range 140 to 159 mm Hg, the probability of escalating treatment was determined by a Bernoulli probability mass function parameterized by weighting functions exploring distinct inertia profiles. Simulating inertia with the weighting function that approximated to clinical practice resulted in ≈50% of individuals failing to achieve their SBP target within the 10-year time horizon. An inverse relationship was observed between measurement error and SBP control. This suggests that the value of accurate SBP measurement is only realized if it changes the underlying probability of inertia—that is, patients/clinicians believe a measurement to be accurate and so are more likely to act upon it. Removal of inertia during treatment initiation (ie, stepped titration until SBP measurement was below target) improved true SBP control for all simulations. Our simulations show that the impact of therapeutic inertia during treatment initiation persists during long-term follow-up. Strategies to remove therapeutic inertia during treatment initiation (ie, dual antihypertensive therapy) are likely to improve long-term BP control irrespective of BP measurement technique.

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Impact of Therapeutic Inertia on Long-Term Blood Pressure Control A Monte Carlo Simulation Study - Accepted Manuscript
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Accepted/In Press date: 27 January 2021
Published date: April 2021
Keywords: antihypertensive agents, blood pressure, hypertension, uncertainty

Identifiers

Local EPrints ID: 450005
URI: http://eprints.soton.ac.uk/id/eprint/450005
ISSN: 0194-911X
PURE UUID: 0649f843-4700-4fbd-a0bf-8960db3a7dad

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Date deposited: 02 Jul 2021 16:33
Last modified: 26 Nov 2021 05:58

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Contributors

Author: Louise Coutts
Author: Lorenzo Zanisi
Author: Anthony S. Wierzbicki
Author: Phil J. Chowienczyk
Author: Christopher N. Floyd

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