{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:29:40Z","timestamp":1787077780834,"version":"build-2736575974"},"reference-count":70,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Population Health and Outcomes"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Amid persistently low blood pressure (BP) control rates and pervasive therapeutic inertia, we evaluated trends in pre- and posttreatment BP before and after 2 major disruptions (the 2017 target\u2011lowering guideline and the COVID\u201119 pandemic) to assess their impact on early hypertension management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This retrospective cohort study of national Veterans Health Administration data included outpatient adults newly diagnosed with hypertension and starting antihypertensive medication between November 13, 2014, and May 31, 2023 (index date). Patients were stratified into 3 periods corresponding to preguideline\/prepandemic (Period 1), postguideline\/prepandemic (Period 2), and postguideline\/postpandemic (Period 3), and into 3 pretreatment systolic BP (SBP) groups based on the average of \u22652 measurements in the 90-day preindex period (&lt;140, 140\u2013160, or \u2265160 mm\u2009Hg). Across periods, multivariable analyses evaluated: (1) mean posttreatment SBP (mean of measurements from days 180\u2013365 postindex); and (2) posttreatment BP control (&lt;140\/90 or &lt;130\/80 mm\u2009Hg).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Among 271\u2009496 Veterans (mean age, 62 years; 92% male; 66% non-Hispanic White), 39%, 32%, and 29% were in Periods 1, 2, and 3, respectively. Adjusted posttreatment SBP across periods was 128, 135, and 142 mm\u2009Hg for the &lt;140, 140 to 160, and \u2265160 groups, respectively. Rates of posttreatment BP control &lt;140\/90 mm\u2009Hg across Periods 1, 2, and 3, respectively, were 82.3%, 83.3%, and 84.2% (SBP &lt;140 group); 64.1%, 66.1%, and 67.3% (140\u2013160 group); and 46.4%, 47.0%, and 48.6% (\u2265160 group). For BP control &lt;130\/80 mm\u2009Hg, rates were 38.2%, 40.0%, and 39.9% (SBP &lt;140 group); 20.7%, 22.0%, and 22.6% (140\u2013160 group); and 15.1%, 15.4%, and 15.2% (\u2265160 group).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Despite the target-lowering guideline and the care-disrupting pandemic, BP levels and control among Veterans remained largely unchanged. At 1 year, only half to two-thirds achieved BP &lt;140\/90 mm\u2009Hg, and few reached &lt;130\/80 mm\u2009Hg, underscoring persistent clinical inertia and the need to improve early hypertension management in the Veterans Health Administration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.125.013272","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T09:00:12Z","timestamp":1785488412000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Blood Pressure Outcomes Among US Veterans Initiating Hypertension Treatment, 2014 to 2023"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-4607","authenticated-orcid":true,"given":"Catherine G.","family":"Derington","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Colorado School of Medicine, Aurora (C.G.D., S.R.)."},{"name":"Adult &amp; Child Center for Outcomes Research &amp; Dissemination, University of Colorado Anschutz Medical Campus, Aurora (C.G.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1295-4341","authenticated-orcid":true,"given":"Haojia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (H.L., Y.Z., C.-C.L., A.F.M.), University of Utah School of Medicine, Salt Lake City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4124-4816","authenticated-orcid":true,"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (H.L., Y.Z., C.-C.L., A.F.M.), University of Utah School of Medicine, Salt Lake City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Chin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (H.L., Y.Z., C.-C.L., A.F.M.), University of Utah School of Medicine, Salt Lake City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7399-2299","authenticated-orcid":true,"given":"Byron C.","family":"Jaeger","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC (B.C.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4649-079X","authenticated-orcid":true,"given":"Jordana B.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (J.B.C.)."},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (J.B.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Muntner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6302-8834","authenticated-orcid":true,"given":"Daichi","family":"Shimbo","sequence":"additional","affiliation":[{"name":"Columbia Hypertension Lab, Division of Cardiology, Department of Medicine, Columbia University, New York, NY (D.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7162-2972","authenticated-orcid":true,"given":"William C.","family":"Cushman","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (W.C.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan R.","family":"Berlowitz","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Massachusetts Lowell (D.R.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-4873","authenticated-orcid":true,"given":"Sridharan","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado School of Medicine, Aurora (C.G.D., S.R.)."},{"name":"US Department of Veterans Affairs Eastern Colorado Health System, Aurora (S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7775-6266","authenticated-orcid":true,"given":"P. 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