Stage 2 hypertension: predictors of failure to achieve blood pressure control and the impact of adding one additional antihypertensive class.
OBJECTIVE
Controlling blood pressure (BP) for patients with stage 2 hypertension remains challenging. This research aimed to: (i) identify predictors of failure to achieve BP control, (ii) determine the association of adding one additional antihypertensive class with achieving BP control, and (iii) describe the prescribed antihypertensive regimens.


METHODS
Electronic medical record data from 25 multi-specialty medical groups in the USA were used. The study cohort included patients with stage 2 hypertension in 2012. BP control rates were determined at 6 months from the date of the stage 2 BP. Using multivariable logistic regression and validation by Monte Carlo simulation, we determined independent baseline predictors of not achieving BP control (<140/90).


RESULTS
Included were 107 903 patients. Baseline predictors of failure to achieve BP control included the following: a prior stage 2 BP, systolic BP ≥ 165, Black race, male sex, income ≤ $35 000, body mass index ≥ 30, age ≥ 65 years, and no office visits. Increasing from single-class to dual-class antihypertensive therapy was associated with a 42% increased odds of achieving BP control (odds ratio 1.42; 95% CI 1.22, 1.64); however, this effect was attenuated as the number of baseline antihypertensive classes increased. The 10 most frequently prescribed regimens accounted for only 40% of all antihypertensive regimens.


CONCLUSIONS
Among patients with stage 2 hypertension, a prior stage 2 BP, a systolic BP ≥ 165, and fewer office visits were strong predictors of failure to achieve BP control. Increasing to dual-class antihypertensive therapy was significantly associated with achieving BP control. There is broad heterogeneity in the antihypertensive regimens prescribed.
Partnership for Health Analytic Research, Beverly Hills, CA, USA.|Rutgers Biomedical and Health Sciences, Newark, NJ, USA.
Christopher G
CG
Rowan
Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, New York, USA.
James
J
Flory
American Medical Group Association, Alexandria, VA, USA.
Nikita
N
Stempniewicz
American Medical Group Association, Alexandria, VA, USA.
John
J
Cuddeback
DaVita Clinical Research, Minneapolis, MN, USA.|DaVita HealthCare Partners, Denver, CO, USA.
Steven M
SM
Brunelli
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D000959:Antihypertensive Agents
blood pressure control; dual-class antihypertensive therapy; encounter frequency; pharmacoepidemiology; predictive model; stage 2 hypertension