| Abstrakt: |
Initiation of antihypertensive medication with combination therapy is recommended for many patients with hypertension to shorten the time needed to reach blood pressure [BP] goals. We examined trends in initiation of combination antihypertensive therapy in an integrated healthcare delivery system from 2008-2014.We identified adults aged ?18 years with a hypertension diagnosis who initiated antihypertensive medication from electronic health records. Antihypertensive medications included angiotensin converting enzyme inhibitors [ACEI], angiotensin receptor blockers, thiazide diuretics, calcium channel blockers, and beta-blockers. Combination therapy was defined as an initial fill with ?2 antihypertensive medication classes as fixed-dose combinations or as separate pills.Among 164,805 patients [mean age 54 years, 50% female, 37% White, 34% Hispanic, 14% Black, and 11% Asian], 58% initiated monotherapy, 40% dual, and 2% triple therapy. Combination therapy use increased from 40% in 2008 to 45% in 2011 and then declined through 2014. A fixed-dose combination of ACEI/thiazide diuretic was the most commonly used combination therapy (80%). Patients with higher levels of BP were more likely to initiate combination therapy (56% for ?160/100 mmHg vs 40% for 140-159/90-99 mmHg vs 29% for 130-139/80-89 mmHg). The trends in use of combination therapy, stratified by BP level, were similar to the overall yearly trend with an increase until 2011 followed by a decline (Figure). Younger patients, men, and blacks were more likely to initiate combination therapy (44% for <65 years vs 36% for ?65 years; 45% for men vs 39% women; 46% for black adults vs 40% white adults).Use of antihypertensive combination therapy did not change substantially between 2008 and 2014. Efforts are needed to increase the initiation of antihypertensive medication with combination therapy, especially among patients with systolic/diastolic BP ?160/100 mmHg. |
