Use of antihypertensive medications and diagnostic tests among privately insured adolescents and young adults with primary versus secondary hypertension.
OBJECTIVE
To compare the use of antihypertensive medications and diagnostic tests among adolescents and young adults with primary versus secondary hypertension.


METHODS
We conducted retrospective cohort analysis of claims data for adolescents and young adults (12-21 years of age) with ≥3 years of insurance coverage (≥11 months/year) in a large private managed care plan during 2003-2009 with diagnosis of primary hypertension or secondary hypertension. We examined their use of antihypertensive medications and identified demographic characteristics and the presence of obesity-related comorbidities. For the subset receiving antihypertensive medications, we examined their diagnostic test use (echocardiograms, renal ultrasounds, and electrocardiograms).


RESULTS
The study sample included 1,232 adolescents and young adults; 84% had primary hypertension and 16% had secondary hypertension. The overall prevalence rate of hypertension was 2.6%. One quarter (28%) with primary hypertension had one or more antihypertensive medications, whereas 65% with secondary hypertension had one or more antihypertensive medications. Leading prescribers of antihypertensives for subjects with primary hypertension were primary care physicians (80%), whereas antihypertensive medications were equally prescribed by primary care physicians (43%) and sub-specialists (37%) for subjects with secondary hypertension.


CONCLUSIONS
The predominant hypertension diagnosis among adolescents and young adults is primary hypertension. Antihypertensive medication use was higher among those with secondary hypertension compared with those with primary hypertension. Further study is needed to determine treatment effectiveness and patient outcomes associated with differential treatment patterns used for adolescents and young adults with primary versus secondary hypertension.
Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan. Electronic address: est@med.umich.edu.
Esther Y
EY
Yoon
Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan.
Lisa
L
Cohn
Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan.
Gary
G
Freed
Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
Albert
A
Rocchini
Division of Pediatric Nephrology, University of Michigan, Ann Arbor, Michigan.
David
D
Kershaw
School of Pharmacy, University of Michigan, Ann Arbor, Michigan.
Frank
F
Ascione
Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan.
Sarah
S
Clark
D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
D000959:Antihypertensive Agents
Adolescents; Blood pressure medication; Diagnostic test use; Primary hypertension; Secondary hypertension