Trends in Initial Antihypertensive Medication Prescribing Among >2.8 Million Veterans Newly Diagnosed With Hypertension, 2000 to 2019.

Autor: Xu Y; Department of Internal Medicine, Division of Epidemiology, Spencer Fox-Eccles School of Medicine University of Utah Salt Lake City UT., Derington CG; Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine University of Utah Salt Lake City UT., Addo DK; Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine University of Utah Salt Lake City UT., He T; George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT., Jacobs JA; Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine University of Utah Salt Lake City UT., Mohanty AF; Department of Internal Medicine, Division of Epidemiology, Spencer Fox-Eccles School of Medicine University of Utah Salt Lake City UT.; George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT., An J; Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA., Cushman WC; Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN., Ho PM; Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO.; Cardiology Section VA Eastern Colorado Health Care System Aurora CO., Bellows BK; Department of Medicine Columbia University New York NY., Cohen JB; Department of Medicine, Renal-Electrolyte and Hypertension Division Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania Philadelphia PA., Bress AP; Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine University of Utah Salt Lake City UT.; George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Oct 15; Vol. 13 (20), pp. e036557. Date of Electronic Publication: 2024 Oct 11.
DOI: 10.1161/JAHA.124.036557
Abstrakt: Background: Among patients diagnosed with high blood pressure (BP), initial dual therapy has been recommended for patients with high pretreatment systolic BP (≥160 mm Hg) since 2003, and first-line β-blocker use without a compelling condition has fallen out of favor in US guidelines.
Methods and Results: This serial cross-sectional study of national Veterans Health Administration data included adult Veterans with incident hypertension initiating antihypertensive medication between January 1, 2000, and December 31, 2019. We assessed annual trends in initial regimens dispensed (index date: first antihypertensive dispense date) by number of classes and unique class combinations used overall and by pretreatment systolic BP (<140, 140 to <160, and ≥160 mm Hg), as well as trends in subgroups (age, sex, race and ethnicity, and comorbidities warranting β-blocker use). Among 2 832 684 eligible Veterans (average age 61 years, 95% men, 65% non-Hispanic White, and 8% with cardiovascular disease), from 2000-2004 to 2015-2019, initial monotherapy increased across all pretreatment systolic BP levels (<140 mm Hg: 62.1% to 66.4%; 140 to <160 mm Hg: 70.7% to 76.8%; ≥160 mm Hg: 64.2% to 69.7%). Initiation of dual therapy decreased across all pretreatment systolic BP levels (<140 mm Hg: 25.0% to 24.2%; 140 to <160 mm Hg: 20.4% to 17.6%; ≥160 mm Hg: 22.7% to 22.0%). Among 2 521 696 Veterans (89% of overall) without a β-blocker-indicated condition in 2015 to 2019, 20% initiated a β-blocker, most commonly as monotherapy.
Conclusions: More than half of US Veterans diagnosed with hypertension with a pretreatment systolic BP ≥160 mm Hg were started on antihypertensive monotherapy. There are disparities between guideline-recommended first-line treatments and the actual regimens initiated for newly diagnosed Veterans with hypertension.
Databáze: MEDLINE
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