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REFLECTIONS
Hypertension
Hypertension Global Newsletter #7 2024

begin with the addition of amlodipine 5 mg. BP was measured both attended (research staff in the room using an automated device) and
unattended (three preprogrammed unobserved BP measures occurring when the researcher was outside the room). Hypertension

Over the six-month follow-up period, fewer participants randomised to Quadpill versus monotherapy experienced ≥1 episodes of TI
(unattended BP, 21/192 [11%] versus 45/192 [23%]; P=0.002; attended BP, 81/196 (33%) versus 109/194 (50%); P=0.005). In patients
with attended BP measures, the proportion of TI episodes was similar in the Quadpill versus initial monotherapy group at all visits.

Among those patients with uncontrolled BP, there were high rates of TI in patients randomised to both Quadpill and monotherapy
after the first follow-up visit: 71% to 89% of patient visits with uncontrolled BP did not receive treatment intensification after week 6.

A multivariable model for predicting treatment intensification found that unattended BP above target at week 6 was associated with a
three-fold increase in the odds of treatment intensification. Similarly, each 5 mmHg increase in SBP at week 6 was associated with a
two-fold increase in the odds of treatment intensification.

The authors noted that clinicians could use both attended and unattended office BP readings to guide treatment decisions. However,
a greater proportion of participants received treatment intensification if their unattended office BP was above target compared with
attended office BP measures. This may be because unattended readings were slightly lower on average.

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