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Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network

BACKGROUND: Knowledge of real‐world antihypertensive use is limited to prevalent hypertension, limiting our understanding of how treatment evolves and its contribution to persistently poor blood pressure control. We sought to characterize antihypertensive initiation among new users. METHODS AND RESU...

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Autores principales: Smith, Steven M., Winterstein, Almut G., Gurka, Matthew J., Walsh, Marta G., Keshwani, Shailina, Libby, Anne M., Hogan, William R., Pepine, Carl J., Cooper‐DeHoff, Rhonda M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973585/
https://www.ncbi.nlm.nih.gov/pubmed/36565195
http://dx.doi.org/10.1161/JAHA.122.026652
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author Smith, Steven M.
Winterstein, Almut G.
Gurka, Matthew J.
Walsh, Marta G.
Keshwani, Shailina
Libby, Anne M.
Hogan, William R.
Pepine, Carl J.
Cooper‐DeHoff, Rhonda M.
author_facet Smith, Steven M.
Winterstein, Almut G.
Gurka, Matthew J.
Walsh, Marta G.
Keshwani, Shailina
Libby, Anne M.
Hogan, William R.
Pepine, Carl J.
Cooper‐DeHoff, Rhonda M.
author_sort Smith, Steven M.
collection PubMed
description BACKGROUND: Knowledge of real‐world antihypertensive use is limited to prevalent hypertension, limiting our understanding of how treatment evolves and its contribution to persistently poor blood pressure control. We sought to characterize antihypertensive initiation among new users. METHODS AND RESULTS: Using Medicaid and Medicare data from the OneFlorida+ Clinical Research Consortium, we identified new users of ≥1 first‐line antihypertensives (angiotensin‐converting enzyme inhibitor, calcium channel blocker, angiotensin receptor blocker, thiazide diuretic, or β‐blocker) between 2013 and 2021 among adults with diagnosed hypertension, and no antihypertensive fill during the prior 12 months. We evaluated initial antihypertensive regimens by class and drug overall and across study years and examined variation in antihypertensive initiation across demographics (sex, race, and ethnicity) and comorbidity (chronic kidney disease, diabetes, and atherosclerotic cardiovascular disease). We identified 143 054 patients initiating 188 995 antihypertensives (75% monotherapy; 25% combination therapy), with mean age 59 years and 57% of whom were women. The most commonly initiated antihypertensive class overall was angiotensin‐converting enzyme inhibitors (39%) followed by β‐blockers (31%), calcium channel blockers (24%), thiazides (19%), and angiotensin receptor blockers (11%). With the exception of β‐blockers, a single drug accounted for ≥75% of use of each class. β‐blocker use decreased (35%–26%), and calcium channel blocker use increased (24%–28%) over the study period, while initiation of most other classes remained relatively stable. We also observed significant differences in antihypertensive selection across demographic and comorbidity strata. CONCLUSIONS: These findings indicate that substantial variation exists in initial antihypertensive prescribing, and there remain significant gaps between current guideline recommendations and real‐world implementation in early hypertension care.
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spelling pubmed-99735852023-03-01 Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network Smith, Steven M. Winterstein, Almut G. Gurka, Matthew J. Walsh, Marta G. Keshwani, Shailina Libby, Anne M. Hogan, William R. Pepine, Carl J. Cooper‐DeHoff, Rhonda M. J Am Heart Assoc Original Research BACKGROUND: Knowledge of real‐world antihypertensive use is limited to prevalent hypertension, limiting our understanding of how treatment evolves and its contribution to persistently poor blood pressure control. We sought to characterize antihypertensive initiation among new users. METHODS AND RESULTS: Using Medicaid and Medicare data from the OneFlorida+ Clinical Research Consortium, we identified new users of ≥1 first‐line antihypertensives (angiotensin‐converting enzyme inhibitor, calcium channel blocker, angiotensin receptor blocker, thiazide diuretic, or β‐blocker) between 2013 and 2021 among adults with diagnosed hypertension, and no antihypertensive fill during the prior 12 months. We evaluated initial antihypertensive regimens by class and drug overall and across study years and examined variation in antihypertensive initiation across demographics (sex, race, and ethnicity) and comorbidity (chronic kidney disease, diabetes, and atherosclerotic cardiovascular disease). We identified 143 054 patients initiating 188 995 antihypertensives (75% monotherapy; 25% combination therapy), with mean age 59 years and 57% of whom were women. The most commonly initiated antihypertensive class overall was angiotensin‐converting enzyme inhibitors (39%) followed by β‐blockers (31%), calcium channel blockers (24%), thiazides (19%), and angiotensin receptor blockers (11%). With the exception of β‐blockers, a single drug accounted for ≥75% of use of each class. β‐blocker use decreased (35%–26%), and calcium channel blocker use increased (24%–28%) over the study period, while initiation of most other classes remained relatively stable. We also observed significant differences in antihypertensive selection across demographic and comorbidity strata. CONCLUSIONS: These findings indicate that substantial variation exists in initial antihypertensive prescribing, and there remain significant gaps between current guideline recommendations and real‐world implementation in early hypertension care. John Wiley and Sons Inc. 2022-12-24 /pmc/articles/PMC9973585/ /pubmed/36565195 http://dx.doi.org/10.1161/JAHA.122.026652 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Smith, Steven M.
Winterstein, Almut G.
Gurka, Matthew J.
Walsh, Marta G.
Keshwani, Shailina
Libby, Anne M.
Hogan, William R.
Pepine, Carl J.
Cooper‐DeHoff, Rhonda M.
Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network
title Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network
title_full Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network
title_fullStr Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network
title_full_unstemmed Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network
title_short Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network
title_sort initial antihypertensive regimens in newly treated patients: real world evidence from the oneflorida+ clinical research network
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973585/
https://www.ncbi.nlm.nih.gov/pubmed/36565195
http://dx.doi.org/10.1161/JAHA.122.026652
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