CARDIOVASCULAR EVENTS ACCORDING TO FOLLOW-UP INTERVAL IN HYPERTENSIVE PATIENTS

Abstract

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.OBJECTIVE: Hypertension is a chronic disease that requires long-term follow-up in many patients. Although the European hypertension guideline recommended that once the BP target is reached, a visit interval of a few months is reasonable, and there might be no difference in BP control between 3-month and 6-month intervals, there was limited evidence regarding shorter intervals of follow-up.This study sought to evaluate the incidences of cardiovascular events and death according to the visit intervals. DESIGN AND METHOD: This Korean Hypertension Cohort (KHC) enrolled 11,043 hypertensive patients and followed up for more than ten years. We evaluated the incidences of cardiovascular events and death according to the visit intervals after stabilization. RESULTS: In this cohort, 28% of patients visited the clinic with intervals of 3 months, followed by visits with intervals of 4 months (23%), 4-6 months (20%), 2 months (18%), more than 6 months (9%), and less than 1 week (2%). Male, lower SBP and low risk patients had larger visit intervals than female, higher SBP, and high-risk patients. Surprisingly, shorter visit intervals of 34-66 days (about 2 months) showed a relatively larger visit-to-visit variation of 13.6 days, suggesting that shorter visit intervals do not always accompany better treatment adherence. The large visit-to-visit variation reaching 89 days of standard deviation in patients with visit interval of more than 6 months also support the decrease in treatment adherence. In the Cox proportional hazards model for cardiovascular events or death according to visit intervals, with adjustment of age, gender, and cardiovascular risk, showed that hypertensive patients with visit intervals of 3-4 months had fewer cardiovascular events than those either with more extended or shorter visit intervals. CONCLUSIONS: Hypertensive patients with visit intervals of 3-4 months had fewer cardiovascular events than those with longer or shorter visit intervals. Although we did not present a possible explanation for this, the increased standard deviation in the more extended interval group suggests that reduced treatment adherence may play a role.