Abstract
BackgroundAfter the 2003 publication of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines, there was a 5–10% increase in patients initiating antihypertensive medication with a thiazide-type diuretic, but most patients still did not initiate treatment with this class. There are few contemporary published data on antihypertensive medication classes filled by patients initiating treatment.Methods and FindingsWe used the 5% random Medicare sample to study the initiation of antihypertensive medication between 2007 and 2010. Initiation was defined by the first antihypertensive medication fill preceded by 365 days with no antihypertensive medication fills. We restricted our analysis to beneficiaries ≥65 years who had two or more outpatient visits with a hypertension diagnosis and full Medicare fee-for-service coverage for the 365 days prior to initiation of antihypertensive medication. Between 2007 and 2010, 32,142 beneficiaries in the 5% Medicare sample initiated antihypertensive medication. Initiation with a thiazide-type diuretic decreased from 19.2% in 2007 to 17.9% in 2010. No other changes in medication classes initiated occurred over this period. Among those initiating antihypertensive medication in 2010, 31.3% filled angiotensin-converting enzyme inhibitors (ACE-Is), 26.9% filled beta blockers, 17.2% filled calcium channel blockers, and 14.4% filled angiotensin receptor blockers (ARBs). Initiation with >1 antihypertensive medication class decreased from 25.6% in 2007 to 24.1% in 2010. Patients initiated >1 antihypertensive medication class most commonly with a thiazide-type diuretic and either an ACE-I or ARB.ConclusionThese results suggest that JNC 7 had a limited long-term impact on the choice of antihypertensive medication class and provide baseline data prior to the publication of the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).
Highlights
These results suggest that JNC 7 had a limited long-term impact on the choice of antihypertensive medication class and provide baseline data prior to the publication of the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
In 2002, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found that in a hypertensive population with at least one additional coronary heart disease (CHD) risk factor, randomization to chlorthalidone, amlodpine, or lisinopril was associated with similar rates of coronary heart disease outcomes [1].Chlorthalidone was associated with a lower risk of heart failure, a secondary outcome
Based in part on the comparative effectiveness results shown in ALLHAT, and due to their lower cost, JNC 7 supported the use of thiazide-type diuretics as first line therapy for those without a compelling indication for treatment with another antihypertensive drug class
Summary
In 2002, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found that in a hypertensive population with at least one additional coronary heart disease (CHD) risk factor, randomization to chlorthalidone (thiazide-type diuretic), amlodpine (calcium channel blocker [CCB]), or lisinopril (angiotensin-converting enzyme inhibitor [ACE-I]) was associated with similar rates of coronary heart disease outcomes [1].Chlorthalidone was associated with a lower risk of heart failure, a secondary outcome. Subsequent trials comparing antihypertensive drug classes on cardiovascular outcomes and a meta-analysis has suggested no substantial differences exist between ACE-Is, angiotensin receptor blockers (ARBs), CCBs, and thiazide-type diuretics [8,9,10,11,12].guidelines and policy statements from various associations and institutions published since JNC 7 have not universally recommended thiazide-type diuretics for patients initiating treatment [13,14,15]. These factors could influence current trends in choices of first-line therapy among US adults. There are few contemporary published data on antihypertensive medication classes filled by patients initiating treatment
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