Alexander R Zheutlin1, Catherine G Derington2, Jordan B King3, Ransmond O Berchie2, Jennifer S Herrick2, Dave L Dixon4, Jordana B Cohen5, Daichi Shimbo6, Ian M Kronish6, Joseph J Saseen7, Paul Muntner8, Andrew E Moran9, Adam P Bress2. 1. Department of Internal Medicine, University of Utah, School of Medicine, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT. Electronic address: alexander.zheutlin@hsc.utah.edu. 2. Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT. 3. Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO. 4. Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA. 5. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 6. Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY. 7. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO; Department of Family Medicine, University of Colorado, School of Medicine, Aurora, CO. 8. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL. 9. Division of General Medicine, Columbia University Irving Medical Center, New York, NY.
Abstract
BACKGROUND: Treating hypertension with antihypertensive medications combinations, rather than one medication (ie, monotherapy), is underused in the United States, particularly in certain race/ethnic groups. Identifying factors associated with monotherapy use despite uncontrolled blood pressure (BP) overall and within race/ethnic groups may elucidate intervention targets in under-treated populations. METHODS: Cross-sectional analysis of National Health and Nutrition Examination Surveys (NHANES; 2013-2014 through 2017-2018). We included participants age ≥20 years with hypertension, taking at least one antihypertensive medication, and uncontrolled BP (systolic BP [SBP] ≥ 140 mmHg or diastolic BP [DBP] ≥ 90 mmHg). Demographic, clinical, and healthcare-access factors associated with antihypertensive monotherapy were determined using multivariable-adjusted Poisson regression. RESULTS: Among 1,597 participants with hypertension and uncontrolled BP, age- and sex- adjusted prevalence of monotherapy was 42.6% overall, 45.4% among non-Hispanic White, 31.9% among non-Hispanic Black, 39.6% among Hispanic, and 50.9% among non-Hispanic Asian adults. Overall, higher SBP was associated with higher monotherapy use, while older age, having a healthcare visit in the previous year, higher body mass index, and having heart failure were associated with lower monotherapy use. CONCLUSION: Clinical and healthcare-access factors, including a healthcare visit within the previous year and co-morbid conditions were associated with a higher likelihood of combination antihypertensive therapy.
BACKGROUND: Treating hypertension with antihypertensive medications combinations, rather than one medication (ie, monotherapy), is underused in the United States, particularly in certain race/ethnic groups. Identifying factors associated with monotherapy use despite uncontrolled blood pressure (BP) overall and within race/ethnic groups may elucidate intervention targets in under-treated populations. METHODS: Cross-sectional analysis of National Health and Nutrition Examination Surveys (NHANES; 2013-2014 through 2017-2018). We included participants age ≥20 years with hypertension, taking at least one antihypertensive medication, and uncontrolled BP (systolic BP [SBP] ≥ 140 mmHg or diastolic BP [DBP] ≥ 90 mmHg). Demographic, clinical, and healthcare-access factors associated with antihypertensive monotherapy were determined using multivariable-adjusted Poisson regression. RESULTS: Among 1,597 participants with hypertension and uncontrolled BP, age- and sex- adjusted prevalence of monotherapy was 42.6% overall, 45.4% among non-Hispanic White, 31.9% among non-Hispanic Black, 39.6% among Hispanic, and 50.9% among non-Hispanic Asian adults. Overall, higher SBP was associated with higher monotherapy use, while older age, having a healthcare visit in the previous year, higher body mass index, and having heart failure were associated with lower monotherapy use. CONCLUSION: Clinical and healthcare-access factors, including a healthcare visit within the previous year and co-morbid conditions were associated with a higher likelihood of combination antihypertensive therapy.
Authors: Paul Muntner; Robert M Carey; Samuel Gidding; Daniel W Jones; Sandra J Taler; Jackson T Wright; Paul K Whelton Journal: J Am Coll Cardiol Date: 2017-11-13 Impact factor: 24.094
Authors: Dave L Dixon; Garima Sharma; Pratik B Sandesara; Eugene Yang; Lynne T Braun; George A Mensah; Laurence S Sperling; Prakash C Deedwania; Salim S Virani Journal: J Am Coll Cardiol Date: 2019-10-01 Impact factor: 24.094
Authors: Catherine G Derington; Jordan B King; Jennifer S Herrick; Daichi Shimbo; Ian M Kronish; Joseph J Saseen; Paul Muntner; Andrew E Moran; Adam P Bress Journal: Hypertension Date: 2020-03-09 Impact factor: 10.190
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391