Abstract 16061: Antihypertensive Therapy Prescribing Pattern Among Patients With Markedly Elevated Blood Pressure in a Real-world Setting

Abstract

Introduction: Combination therapy with two or more antihypertensive agents is recommended for management of patients with markedly elevated blood pressure (systolic blood pressure [SBP] ≥160 mmHg or diastolic blood pressure [DBP] ≥100 mmHg) by the 2017 AHA/ACC hypertension guideline. Using electronic health records (EHR) data from a large health system, we characterized real-world antihypertensive drug prescribing patterns and assessed guideline adherence among ambulatory patients with markedly elevated BP. Methods: Our cohort included patients aged 18-85 years with at least 2 outpatient visits in the Yale New Haven Hospital System between January 1 st , 2013 and December 31 st , 2018, resulting in a total of 665,691 patients. We defined the phenotype of markedly elevated BP as two consecutive outpatient visits with SBP ≥160 mmHg or DBP ≥100 mmHg. We described the number and class of antihypertensive drugs (previously taken and newly prescribed) at the second visit with BP ≥160/100 mmHg. Results: We identified 38,098 patients with markedly elevated BP with a mean age of 62.4 (SD: 13.7) years; 47.9% were male; and 67.8%, 20.9%, and 9.3% were White, Black and Hispanic. Among them, 49.3% were not on any antihypertensive drugs at the end of the second visit, 26.2% had one active antihypertensive drug prescription, and 24.5% had two or more agents prescribed (Figure). Among patients with two or more antihypertensive drug prescriptions, the most common drug class combination prescribed was diuretic/ACE inhibitor (10.2%), followed by diuretic/ARB (9.3%), and ACE inhibitor/calcium channel blocker (6.5%). The low prescription of combination therapy was consistent across age, gender, and race subgroups. Conclusions: Prescribing of guideline-recommended combination antihypertensive drugs for patients with markedly elevated BP is suboptimal. Major opportunities exist for improving the guideline adherence of antihypertensive drug prescription in this population.