Abstract 10657: Fidelity to Antihypertensive Treatment Regimens in Patients with Comorbid Primary Hypertension and Diabetes in the United States: A Retrospective Cohort Analysis
INTRODUCTION: Patients with diabetes mellitus and concomitant hypertension are at increased risk for cardiovascular and renal complications, and death. Disruption of antihypertensive treatment may negatively affect clinical outcome.
HYPOTHESIS: Treatment fidelity with antihypertensive regimens is related to hypertensive outcomes in patients with comorbid diabetes and hypertension.
METHODS: This was a retrospective cohort analysis (MCEED database, Thomson's MarketScan) of patients (18-65 y) with diabetes and primary hypertension who initiated antihypertensive drug therapy in 2007-2009. Eligible patients were followed 12 months before and 12 months after the index event (date of antihypertensive drug initiation). Diagnostic and medication utilization data were collected. Drug cohorts were based on index antihypertensive class with separate classes for individual and combination therapies. Outcomes were treatment fidelity and postindex hypertensive events. Treatment fidelity was defined by the presence of ≥1 pharmacy claim for the index antihypertensive in each postindex quarter.
RESULTS: A total of 183,774 patients met the selection criteria, with 14 drug cohorts defined. Monotherapy with angiotensin-converting enzyme inhibitors (25%), beta blockers (10%), and angiotensin II receptor blockers (9%) were the most common index treatments. In total, 64.3% of patients were using a renin-angiotensin-aldosterone system (RAAS) blocking agent as monotherapy or in combination on the index date. Treatment fidelity rates declined over 4 quarters (16%-53%) for all cohorts; the largest declines occurred in the earliest quarters. A pattern of higher fidelity was associated with combination vs monotherapy and with RAAS blocking agents vs beta blockers, calcium channel blockers, diuretics, and non-RAAS combinations. At the end of Q4, 4%-31% of patients in the cohorts were not on antihypertensive medications. Hypertensive events were less likely in patients with high treatment fidelity.
CONCLUSIONS: Use of RAAS blocking agents was lower than expected based on guideline recommendations. Treatment fidelity of antihypertensive agents is associated with positive hypertensive outcomes in patients with comorbid hypertension and diabetes.
- © 2011 by American Heart Association, Inc.