• Jeremy B Sussman, Donna M Zulman, Rodney Hayward, Timothy P Hofer, and Eve A Kerr.
• Veterans Affairs Center for Clinical Management Research, HSR&D Center of Excellence, Ann Harbor, MI, USA. jeremysu@med.umich.edu
• Am J Manag Care. 2020 Dec 8; 18 (8): 414-20.

ObjectivesConsidering cardiovascular (CV) risk could make clinical care more efficient and individualized, but most practice guidelines focus on single risk factors. We sought to determine if hypertension treatment intensification (TI) is more likely in patients with elevated CV risk.Study DesignProspective cohort study of 856 US veterans with diabetes and elevated blood pressure (BP).MethodsWe used multilevel logistic regression to compare TI across 3 CV risk groups: those with history of heart disease, a high-risk primary prevention group (10-year event risk >20% but no history of heart disease), and those with low/ medium CV risk (10-year event risk <20%).ResultsThere were no significant differences in TI rates across risk groups, with adjusted odds ratios (ORs) of 1.19 (95% confidence interval 0.77-1.84) and 1.18 (0.76-1.83) for high-risk patients and those with a history of CVD, respectively, compared with those of low/medium risk. Several individual risk factors were associated with higher rates of TI: systolic BP, mean BP in the prior year, and higher glycated hemoglobin. Self-reported home BP <140/90 mm Hg was associated with lower rates of TI. Incorporating CV risk into TI decision algorithms could prevent an estimated 38% more cardiac events without increasing the number of treated patients.ConclusionsWhile an individual's BP alters clinical decisions about TI, overall CV risk does not appear to play a role in clinical decision making. Adoption of TI decision algorithms that incorporate CV risk could substantially enhance the efficiency and clinical utility of CV preventive care.

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