The Impact of Lost Therapeutic Benefit ( LTB ) in High‐Risk Hypertensive Patients: 2‐Year Follow‐Up Data from the Australian REACH Registry

Summary Objective The aim of the study is to determine the extent of lost therapeutic benefit ( LTB ) in the hypertensive patients, and to determine the relationship between the presence of LTB and clinical outcomes. Methods Prospective‐cohort study of n = 2856 patients with or at high risk of atherothrombosis. LTB was calculated as the proportion of patients receiving blood pressure medication who were not attaining guideline blood pressure ( BP ) control targets (<140/90 mmHg). Logistic regression analysis was performed to identify predictors of LTB at baseline, and propensity score matching ( PSM ) was undertaken to estimate the treatment effects by matching case LTB and control non‐ LTB cohorts based on the nearest neighbor matching. Results Of the total sample of 2856, 45.6% had uncontrolled BP , and LTB was present in 46.7% patients. The likelihood of LTB was less in males ( OR  = 0.78 [95% CI ; 0.64–0.97]), and those with a previous myocardial infarction ( OR  = 0.66 [0.53–0.81]) or heart failure ( OR  = 0.58 [0.42–0.82]). LTB was more common in those with diabetes ( OR  = 1.44 [1.16–1.79]), aged >65 years ( OR  = 1.36 [1.06–1.75]) and having an ABI < 0.09 in either leg at rest ( OR  = 1.30 [1.02–1.75]). Following PSM , the combination of ischemic events (55–64 age category) was more likely to occur in the LTB compared with non‐ LTB group (4.38% and 0.68%, respectively [ P  = 0.046]). Conclusion Presence of HF , previous MI and being male decreased the likelihood of LTB , while presence of diabetes, age > 65 and ABI  < 0.09 increased the risk of LTB . Patients with LTB in age category 55–64 had higher incidence of vascular events compared with those with non‐ LTB .