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Lin PD, Rifas‐Shiman S, Merriman J, Petimar J, Yu H, Daley MF, Janicke DM, Heerman WJ, Bailey LC, Maeztu C, Young J, Block JP. Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records. J Am Heart Assoc 2024; 13:e032197. [PMID: 38639340 PMCID: PMC11179868 DOI: 10.1161/jaha.123.032197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Affiliation(s)
- Pi‐I Debby Lin
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Sheryl Rifas‐Shiman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - John Merriman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Joshua Petimar
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Han Yu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente ColoradoAuroraCOUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFLUSA
| | - William J. Heerman
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - L. Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Carlos Maeztu
- Department of Health Outcomes and Biomedical InformaticsUniversity of FloridaGainesvilleFLUSA
| | - Jessica Young
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Jason P. Block
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
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Smith KM, Keshwani S, Walsh MG, Winterstein AG, Gurka MJ, Libby A, Hogan WR, Pepine CJ, Cooper-DeHoff RM, Smith SM. Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Florida Medicaid and Medicare Recipients in the OneFlorida+ Research Consortium. Hypertension 2024; 81:e7-e9. [PMID: 38232142 DOI: 10.1161/hypertensionaha.123.21901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Kayla M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
| | - Marta G Walsh
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
- Now with Mayo Clinic, Rochester, MN (M.G.W.)
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine (M.J.G.), University of Florida, Gainesville, FL
| | - Anne Libby
- Department of Emergency Medicine, School of Medicine, University of Colorado Denver, Denver, CO (A.L.)
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine (W.R.H.), University of Florida, Gainesville, FL
- Now with Data Science Institute, Medical College of Wisconsin, Milwaukee, WI (W.R.H.)
| | - Carl J Pepine
- Divisio of Cardiovascular Medicine, Department of Medicine, College of Medicine (C.J.P., R.M.C.-D., S.M.S.), University of Florida, Gainesville, FL
| | - Rhonda M Cooper-DeHoff
- Divisio of Cardiovascular Medicine, Department of Medicine, College of Medicine (C.J.P., R.M.C.-D., S.M.S.), University of Florida, Gainesville, FL
- Department of Pharmacotherapy and Translational Research, College of Pharmacy (R.M.C.-D.), University of Florida, Gainesville, FL
| | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
- Divisio of Cardiovascular Medicine, Department of Medicine, College of Medicine (C.J.P., R.M.C.-D., S.M.S.), University of Florida, Gainesville, FL
- Center for Integrative Cardiovascular and Metabolic Disease (S.M.S), University of Florida, Gainesville, FL
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