title: Antihypertensive medication classes used among medicare beneficiaries initiating treatment in 2007-2010.
abstract: BACKGROUND
  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 5-10% 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.
  
  
  RESULTS
  We used the 5% 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. We restricted our analysis to beneficiaries ≥ 65 years who had two or more outpatient visits with a hypertension diagnosis and full Medicare fee-for-service coverage for the 365 days prior to initiation of antihypertensive medication. Between 2007 and 2010, 32,142 beneficiaries in the 5% Medicare sample initiated antihypertensive medication. Initiation with a thiazide-type diuretic decreased from 19.2% in 2007 to 17.9% in 2010. No other changes in medication classes initiated occurred over this period. Among those initiating antihypertensive medication in 2010, 31.3% filled angiotensin-converting enzyme inhibitors (ACE-Is), 26.9% filled beta blockers, 17.2% filled calcium channel blockers, and 14.4% filled angiotensin receptor blockers (ARBs). Initiation with >1 antihypertensive medication class decreased from 25.6% in 2007 to 24.1% in 2010. Patients initiated >1 antihypertensive medication class most commonly with a thiazide-type diuretic and either an ACE-I or ARB.
  
  
  CONCLUSIONS
  These results suggest that 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).
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Shia T
authors.initials: ST
authors.lastname: Kent
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Diaz
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
authors.affiliation: Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America; Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D006278:Medicare; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics