title: Antihypertensive medication changes and blood pressure goal achievement in a managed care population.
abstract: This study examined achievement of blood pressure (BP) goals, changes in antihypertensive therapy and reasons for these changes among adults with hypertension initiating angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or calcium channel blockers (CCBs). Claims data were examined for changes to medication regimens. Patient charts for 501 patients provided BP levels and reasons for changing medications. BP goal achievement was highest for initiators of ARBs (81.4%), compared with ACEIs (75.5%; P=NS) and CCBs (68.9%; P<0.01). Changes in antihypertensive therapy were least likely among ARB recipients (59.9%) compared with ACEIs (71.86%; P=0.02) and CCBs (74.85%; P<0.01). Failure to achieve BP goals was the most common reason for change in therapy (ARB, 32.9%; ACEI, 42.5%, P=NS; CCB, 47.9%, P<0.01). Although most patients achieved target BP goals, many required changes in treatment regimens. Initial choice of antihypertensive therapy may mitigate changes in therapies and better achieve BP goals.
authors.affiliation: i3 Innovus, Health Economics and Outcomes, Eden Prairie, MN 55344, USA. nicole.engel-nitz@i3innovus.com
authors.forename: N M
authors.initials: NM
authors.lastname: Engel-Nitz
authors.forename: T
authors.initials: T
authors.lastname: Darkow
authors.forename: H
authors.initials: H
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D011307:Drug Prescriptions; D057915:Drug Substitution; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers