In hypertensive patients with diabetes, shorter intervals between encounters with physicians are associated with a faster decrease in blood pressure and earlier blood pressure normalization – particularly intervals shorter than those currently recommended, according to a study published online May 24 in Hypertension.
Alexander Turchin, M.D., of Brigham and Women’s Hospital in Boston, and colleagues performed a retrospective cohort study of 5,042 patients who were treated at primary care practices affiliated with two academic hospitals between 2000 and 2005.
The researchers found that patients with an average interval between encounters of one month or less achieved blood pressure normalization after a median of 1.5 months at the rate of 28.7 mm Hg/month, while those with an average interval of more than one month achieved normalization after a median of 12.2 months at the rate of 2.6 mm Hg/month.
They also found that an average encounter interval of two weeks or less was associated with a faster median time to normalization than an interval between two weeks and one month (0.7 versus 1.9 months).
“Based on our findings, optimal encounter intervals may be shorter than what is currently recommended,” the authors conclude. “Interventional studies are now needed to confirm the direction of causality in these findings and to provide evidence-based guidance for choosing encounter intervals for the thousands of primary care physicians who care for these patients.”
Abstract – The relationship between encounter frequency (average number of provider-patient encounters over a period of time) and blood pressure for hypertensive patients is unknown. We tested the hypothesis that shorter encounter intervals are associated with faster blood pressure normalization. We performed a retrospective cohort study of 5042 hypertensive patients with diabetes mellitus treated at primary care practices affiliated with 2 academic hospitals between 2000 and 2005. Distinct periods of continuously elevated blood pressure (???130/85 mm Hg) were studied. We evaluated the association of the average encounter interval with time to blood pressure normalization and rate of blood pressure decrease. Blood pressure of the patients with the average interval between encounters ???1 month normalized after a median of 1.5 months at the rate of 28.7 mm Hg/month compared with 12.2 months at 2.6 mm Hg/month for the encounter interval >1 month (P<0.0001 for all). Median time to blood pressure normalization was 0.7 versus 1.9 months for the average encounter interval ???2 weeks versus between 2 weeks and 1 month, respectively (P<0.0001). In proportional hazards analysis adjusted for patient demographics, initial blood pressure, and treatment intensification rate, a 1 month increase in the average encounter interval was associated with a hazard ratio of 0.764 for blood pressure normalization (P<0.0001). Shorter encounter intervals are associated with faster decrease in blood pressure and earlier blood pressure normalization. Greatest benefits were observed at encounter intervals (???2 weeks) shorter than what is currently recommended.
Alexander Turchin; Saveli I. Goldberg; Maria Shubina; Jonathan S. Einbinder; and Paul R. Conlin