Christopher G Rowan1,2, James Flory3, Nikita Stempniewicz4, John Cuddeback4, Steven M Brunelli5,6. 1. Partnership for Health Analytic Research, Beverly Hills, CA, USA. 2. Rutgers Biomedical and Health Sciences, Newark, NJ, USA. 3. Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, New York, USA. 4. American Medical Group Association, Alexandria, VA, USA. 5. DaVita Clinical Research, Minneapolis, MN, USA. 6. DaVita HealthCare Partners, Denver, CO, USA.
Abstract
BACKGROUND AND 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.
BACKGROUND AND 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.
Authors: Kevin Fiscella; Hua He; Mechelle Sanders; Andrea Cassells; Jennifer K Carroll; Stephen K Williams; Jerry Cornell; Tameir Holder; Chamanara Khalida; Jonathan N Tobin Journal: J Gen Intern Med Date: 2021-08-11 Impact factor: 5.128
Authors: Da Feng; Ray Serrano; Ting Ye; Shangfeng Tang; Lei Duan; Yuan Xu; Jian Yang; Yuan Liang; Shanquan Chen; Zhanchun Feng; Liang Zhang Journal: Int J Environ Res Public Health Date: 2016-12-21 Impact factor: 3.390