SALT LAKE CITY — While more than half of U.S. veterans diagnosed with hypertension with a pretreatment systolic BP ≥160 mm Hg were started on antihypertensive monotherapy, disparities existed between guideline-recommended first-line treatments and the actual regimens initiated, according to a new study.
“Among patients diagnosed with high blood pressure (BP), initial dual therapy has been recommended for patients with high pretreatment systolic BP (≥160 mm Hg) since 2003, and first-line β-blocker use without a compelling condition has fallen out of favor in U.S. guidelines”, according to the authors from Spencer Fox-Eccles School of Medicine University of Utah and the George E. Wahlen VAMC, both in Salt Lake City.
The serial cross-sectional study of national VHA data included veterans with incident hypertension initiating antihypertensive medication between Jan. 1, 2000, and Dec. 31, 2019. The results were reported in the Journal of the American Heart Association.1
The researchers assessed annual trends in initial regimens dispensed (index date: first antihypertensive dispense date) by number of classes and unique class combinations used overall and by pretreatment systolic BP (<140, 140 to <160 and ≥160 mm Hg), as well as trends in subgroups (age, sex, race and ethnicity and comorbidities warranting β-blocker use).
Results indicated that, among about 2.8 million eligible veterans with an average age of 61 from 2000-2004 to 2015-2019, initial monotherapy increased across all pretreatment systolic BP levels (<140 mm Hg: 62.1% to 66.4%; 140 to <160 mm Hg: 70.7% to 76.8%; ≥160 mm Hg: 64.2% to 69.7%). The veterans were 95% men, 65% non-Hispanic white, and 8% with cardiovascular disease.
“Initiation of dual therapy decreased across all pretreatment systolic BP levels (<140 mm Hg: 25.0% to 24.2%; 140 to <160 mm Hg: 20.4% to 17.6%; ≥160 mm Hg: 22.7% to 22.0%, according to the authors. “Among 2 521 696 veterans (89% of overall) without a β-blocker-indicated condition in 2015 to 2019, 20% initiated a β-blocker, most commonly as monotherapy.”
- Xu Y, Derington CG, Addo DK, He T, Jacobs JA, Mohanty AF, An J, Cushman WC, Ho PM, Bellows BK, Cohen JB, Bress AP. Trends in Initial Antihypertensive Medication Prescribing Among >2.8 Million Veterans Newly Diagnosed With Hypertension, 2000 to 2019. J Am Heart Assoc. 2024 Oct 15;13(20):e036557. doi: 10.1161/JAHA.124.036557. Epub 2024 Oct 11. PMID: 39392155.
