title: Trends in Antihypertensive Medication Use Among US Patients With Resistant Hypertension, 2008 to 2014.
abstract: 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.
authors: From the Department of Pharmacotherapy and Translational Research (A.Y.H., S.M.S.) and Department of Pharmaceutical Outcomes and Policy (C.D.), College of Pharmacy, and Department of Community Health and Family Medicine, College of Medicine (A.Y.H., S.M.S.), University of Florida, Gainesville.
authors: Andrew Y
authors: AY
authors: Hwang
authors: From the Department of Pharmacotherapy and Translational Research (A.Y.H., S.M.S.) and Department of Pharmaceutical Outcomes and Policy (C.D.), College of Pharmacy, and Department of Community Health and Family Medicine, College of Medicine (A.Y.H., S.M.S.), University of Florida, Gainesville.
authors: Chintan
authors: C
authors: Dave
authors: From the Department of Pharmacotherapy and Translational Research (A.Y.H., S.M.S.) and Department of Pharmaceutical Outcomes and Policy (C.D.), College of Pharmacy, and Department of Community Health and Family Medicine, College of Medicine (A.Y.H., S.M.S.), University of Florida, Gainesville. ssmith@cop.ufl.edu.
authors: Steven M
authors: SM
authors: Smith
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000379:methods; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002752:Chlorthalidone / Q000627:therapeutic use*; D015331:Cohort Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013148:Spironolactone / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D006852:Hydrochlorothiazide; D013148:Spironolactone; D002752:Chlorthalidone
keywords: antihypertensive agents; chlorthalidone; hypertension; resistant hypertension; spironolactone; trends