Abstract 15819: Changes in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension, Impact of the JNC 7 Guidelines
Background: The national hypertension treatment guideline recommends using thiazide diuretics as initial drug therapy for most patients with uncomplicated hypertension, and also using two or more antihypertensive agents from different classes to achieve the blood pressure treatment goal.
Methods: We analyzed data from the National Health and Nutrition Examination Survey 1999-2002 and 2005-2008 to examine changes in antihypertensive medication use and blood pressure control among US adults with hypertension. Hypertension was defined as blood pressure of at least 140/90 mmHg or 130/80 mmHg in patients with diabetes or chronic kidney disease, or currently taking prescription medication for high blood pressure. Antihypertensive agents reported by survey participants were identified from the prescription medication data.
Results: The prevalence of antihypertensive medication use among US adults with hypertension increased from 60% in 1999-2002 to 69% in 2005-2008 (P< 0.01). Most notably, there was a large increase in the use of multiple antihypertensive agents (from 34% to 42%, P< 0.01). Overall, the use of thiazide diuretics, β-blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers increased by 30%, 49%, 26% and 92% respectively. The use of calcium channel blockers remained relatively constant. Consistent with increased antihypertensive medication use, blood pressure control improved significantly across all age, gender, and race/ethnicity groups. By 2005-2008, 68% of persons with uncomplicated hypertension had achieved the JNC 7 therapeutic goal, while only 33% of hypertensive persons with chronic kidney disease or 36% of hypertensive persons with diabetes had achieved the JNC therapeutic goal. After controlling for age, gender, race/ethnicity, cardiovascular disease, diabetes, and chronic kidney disease, hypertensive persons who received polytherapy were 42% more likely to achieve blood pressure control compared to those who received monotherapy.
Conclusions: Evidence-based clinical recommendations appear to have had an impact on antihypertensive prescribing/utilization patterns and blood pressure control.
- © 2011 by American Heart Association, Inc.