Does earlier attainment of blood pressure goal translate into fewer cardiovascular events?

Recently, clinical trial data showed that rapid attainment of goal blood pressure (BP) reduces the risk for cardiovascular disease (CVD) events. It is unknown whether patient characteristics linked to the magnitude of CVD risk influence the speed of BP control. Time to attain goal systolic BP (SBP) in Kaplan-Meier survival curves was contrasted for strata of baseline characteristics and intensity of hypertension treatment. Survival analyses showed that albuminuria, diabetes, increased body mass index, millimeters of mercury above Joint National Committee (JNC) SBP goal, higher Framingham risk score, older age, depressed estimated glomerular filtration rate, and greater intensity of antihypertensive drug treatment all predicted slower JNC SBP goal attainment (P < 0.015); the intensity of antihypertensive drug therapy when goal BP was attained was also greater in all conditions linked to slow goal attainment. Cox proportional hazards model that included the above patient characteristics revealed all characteristics slowed attainment of JNC SBP goals (P < 0.03). Thus, patient characteristics influence speed of BP control and practitioners should avoid therapeutic inertia.