After 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 five to 10 percent 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.
Dr. Shia T. Kent, postdoctoral trainee in the department of epidemiology at the University of Alabama at Birmingham, used the five percent 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. Co-investigators include department colleague Dr. Paul Muntner, professor and vice chair, Dr. Suzanne Oparil, professor in the division of cardiovascular disease, Ms. Lei Huang, statistician I in the department of epidemiology, and Dr. Meredith L. Kilgore, professor and chair in the department of health organization and policy.
The researchers restricted their analysis to beneficiaries 65 years and older with hypertension diagnosis and full Medicare fee-for-service coverage. Between 2007 and 2010, a total of 32,142 beneficiaries in the five percent Medicare sample initiated antihypertensive medication. Initiation with a thiazide-type diuretic decreased from 19.2 percent in 2007 to 17.9 percent in 2010. No other changes in medication classes initiated occurred over this period. Among those subjects initiating antihypertensive medication in 2010, 31.3 percent filled angiotensin-converting enzyme inhibitors (ACE-Is), 26.9 percent filled beta blockers, 17.2 percent filled calcium channel blockers, and 14.4 percent filled angiotensin receptor blockers (ARBs). Initiation with more than one antihypertensive medication class decreased from 25.6 percent in 2007 to 24.1 percent in 2010. Patients initiated more than one antihypertensive medication class most commonly with a thiazide-type diuretic and either an ACE-I or ARB.
The team concluded that these results suggest 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).
“Antihypertensive Medication Classes Used among Medicare Beneficiaries Initiating Treatment in 2007-2010” was published in August in PLOS One.