Trends in Antihypertensive Medication Use Among US Patients With Resistant Hypertension, 2008 to 2014

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 68; no. 6; pp. 1349 - 1354
• Main Authors: Hwang, Andrew Y, Dave, Chintan, Smith, Steven M
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.12.2016
• Subjects: Adult; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - pharmacology; Antihypertensive Agents - therapeutic use; Blood Pressure Determination - methods; Calcium Channel Blockers - therapeutic use; Chlorthalidone - therapeutic use; Cohort Studies; Drug Resistance; Drug Therapy, Combination; Drug Utilization - trends; Female; Follow-Up Studies; Humans; Hydrochlorothiazide - therapeutic use; Hypertension - diagnosis; Hypertension - drug therapy; Male; Middle Aged; Patient Safety; Retrospective Studies; Risk Assessment; Severity of Illness Index; Spironolactone - therapeutic use; Treatment Outcome; United States; chlorthalidone; antihypertensive agents; hypertension; resistant hypertension; spironolactone; trends
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.116.08128

Little is known of US trends in antihypertensive drug use for patients with treatment-resistant hypertension (TRH). We analyzed antihypertensive use among patients with TRH (treated with ≥4 antihypertensive drugs concurrently) from July 2008 through December 2014 using Marketscan administrative data. We included adults aged 18 to 65 years, with ≥6 months of continuous enrollment, a hypertension diagnosis, and ≥1 episode of overlapping use of ≥4 antihypertensive drugs; patients with heart failure were excluded. We identified 411 652 unique TRH episodes from 261 652 patients with a mean age of 55.9 years. From 2008 to 2014, we observed an increased prevalence, among TRH episodes, of β-blockers (+6.8% [79% to 85.8%]) and dihydropyridine calcium antagonists (+8.1% [69.1% to 77.2%]), and a decreased prevalence of angiotensin-converting enzyme inhibitors (−12.5% [60.4% to 47.9%]) and nondihydropyridine calcium antagonists (−5.0% [15% to 10%]). The prevalence of most other classes changed by <5% from 2008 to 2014. Thiazide diuretic use was largely unchanged from 2008 to 2014, with hydrochlorothiazide being by far the most prevalent thiazide diuretic; chlorthalidone use increased only modestly (+2.6% [3.8% to 6.4%]). Aldosterone antagonist use increased only modestly (+2.9% [7.3% to 10.2%]). Use of optimal regimens increased steadily (+13.8% [50.8% to 64.6%]) during the study period, whereas combined angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use declined (−11.4% [17.7% to 6.3%]). Our results highlight the persistent infrequent use of recommended therapies in TRH, including spironolactone and chlorthalidone, and suggest a need for better efforts to increase the use of such approaches in light of recent evidence demonstrating their efficacy.