ANTIHYPERTENSIVE TREATMENT EVALUATION IN A MULTIMORBIDITY AND POLYPHARMACY TRIAL (ATEMPT): A RANDOMISED CONTROLLED TRIAL
Rahimi K., Majert J., Nazarzadeh M., Ramakrishnan R., Bidel Z., Hedgecott D., Perez-Crespillo A., Turpie W., Akhtar N., Allison M., Court CA., Billot L., Kotecha D., Potter J.
Objective: Older patients with multimorbidity and polypharmacy have been underrepresented in previous clinical trials of antihypertensive treatment. Thus, it is unclear how to best manage blood pressure (BP) in this patient group. Figure. Mean systolic pressure in the two treatment groups over the course of the trial. Design and method: ATEMPT was a home-based, two-armed, parallel-group, partially blinded randomised controlled clinical trial. Individuals aged 65 years or over with multimorbidity (three or more chronic conditions) or polypharmacy (5 or more types of medications) with a systolic BP of 115 - 165 mmHg were recruited. Participants were randomised to up to two more versus up to two fewer classes of antihypertensive medications, depending on their baseline systolic BP and any pre-existing antihypertensive treatments. The primary outcome of the trial was change in home-measured BP. Secondary outcomes included cognitive function and health-related quality of life measured with validated instruments. Results: 230 participants aged 76.0 years (SD 6.1) were recruited. Participants were taking 5.7 (2.4) non-antihypertensive medications at baseline and had four comorbid conditions. Using a dynamic randomisation algorithm, 126 participants were assigned to more and 104 to fewer antihypertensives. After a median of 10.3 months follow-up (IQR 4.2), the average number of antihypertensives per participant was 3.0 (SD 1.4) and 1.9 (SD 1.5), in the more vs fewer antihypertensive arms, respectively (p = 0.001). Mean systolic BP was 133 mmHg (SD 14.4) and 134 mmHg (16.5) at baseline and changed to 122 mmHg (SD 10.5) and 133 mmHg (15.3), in the more vs fewer antihypertensive arms, respectively (p = 0.002) (Figure). There was no meaningful difference in cognitive function, health-related quality of life, frailty score or the occurrence of serious adverse events between treatment arms. Dizziness and fatigue were more commonly reported among participants assigned to more antihypertensives. Conclusions: The decentralised design of ATEMPT enabled the participation of older mostly non-hypertensive individuals with multimorbidity and polypharmacy from home. The remote intervention led to a meaningful reduction in systolic BP with no effect on the quality of life or cognitive function.