Antihypertensive Medication Use Among US Adults With Hypertension

Abstract

Background— High blood pressure can be controlled through existing antihypertensive drug therapy. This study examined trends in prescribed antihypertensive medication use among US adults with hypertension and compared drug utilization patterns with recommendations of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Methods and Results— Persons aged ≥18 years from the National Health and Nutrition Examination Surveys were identified as hypertensive on the basis of either a blood pressure ≥140/90 mm Hg or self-reported current treatment for hypertension with a prescription medication. In 1999–2002, 62.9% of US hypertensive adults took a prescription antihypertensive medication compared with 57.3% during 1988–1994 ( P <0.01). Men had the greatest increase in antihypertensive medication use (47.5%, 1988–1994 versus 57.9%, 1999–2002 [ P <0.001]). In both surveys, antihypertensive medication use increased with age, was lower among men than among women, and was lower among Mexican Americans than among non-Hispanic whites and blacks. Multiple antihypertensive drug use increased from 29.1% to 35.8% ( P <0.001). Polytherapy with a calcium channel blocker, β-blocker, or angiotensin-converting enzyme inhibitor significantly increased by 30%, 42%, and 68%, respectively, whereas monotherapy with a diuretic or β-blocker significantly decreased. For hypertensives with diabetes, congestive heart failure, or a prior heart attack, the utilization patterns closely followed the Sixth Joint National Committee guideline recommendations. Conclusions— Antihypertensive medication use and multiple antihypertensive medication use among US hypertensive adults increased over the past 10 years, but disparities by sociodemographic factors continue to exist.

Between-country variation in the utilization of antihypertensive agents: guidelines and clinical practice

“…Furthermore, the lack of convergence between international guidelines has also been suggested to play a role. 28,29 Of course, it is not realistic to assume that preferences in hypertension guidelines are always reflected in drug utilization, given the nature of the disease, the fact that the majority of patients may not be 'uncomplicated' (although a recent study in an American population estimated this to be about 69% of patients 30 ), the various indications of the drugs, and the lag time between guideline publication and clinical uptake. However, guidelines are an important tool to translate research into clinical practice, and guidelines such as the Norwegian, which emphasize mono-therapy with a drug hardly popular in dayto-day practice, may find the obstacles posed by established prescribing patterns especially large.…”

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

“…Although data from RCTs suggest that only 12% of patients stopped taking combination therapy, 8 our data showed higher rates of stopping treatment, which are consistent with rates reported among patients taking antihypertensive drugs in nontrial settings. [16][17][18] However, we have enhanced the existing evidence by showing that most pa tients who stopped combination therapy showed relatively minor changes in glomerular filtration rate and serum potassium levels before they stopped taking the drug. This evidence suggests that these factors were not why most patients stopped the combination therapy.…”

Changes in Antihypertensive Prescribing During US Outpatient Visits for Uncomplicated Hypertension Between 1993 and 2004

“…3,4 Appropriate pharmacotherapy for uncomplicated hypertension assumes paramount importance to public health because Ϸ70% of US hypertensive adults lack comorbidities that compel the use of certain antihypertensive drug classes. 5 The US Joint National Committee (JNC) has published a series of guidelines that recommend appropriate antihypertensive therapy based on the best available evidence. JNCrecommended first-line drug therapy for uncomplicated hypertension has evolved over time.…”