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Trends in Antihypertensive Medication Use and Blood Pressure Control Among United States Adults With Hypertension: The National Health and Nutrition Examination Survey, 2001 to 2010
Study Questions:
What are recent trends in the use and impact of antihypertensive medications among hypertensive adults in the United States?
Methods:
Person-level data from 2001 to 2010 from the National Health and Nutrition Examination Surveys (NHANES) were used to track trends in treating and controlling hypertension among adults in the United States.
Results:
The prevalence of antihypertensive medication use increased from 63.5% in 2001 to 2002 to 77.3% in 2009 to 2010 (p < 0.01). There was a large increase in the use of multiple antihypertensive agents (from 36.8% to 47.7%, p > 0.01). Blood pressure (BP) control rates increased from 29% to 47%. Diuretics remained the most commonly used antihypertensive drug class during the 10-year period, with more than one third of hypertensive adults taking diuretics in 2009 to 2010, an increase of 19% from 2001 to 2002 (p = 0.01). Lower odds of BP control were seen in older Americans, non-Hispanic blacks, diabetics, and those with chronic kidney disease.
Conclusions:
Over the past decade, antihypertensive medication use and BP control have improved among adults in the United States, and significantly more patients are on combination therapy. Key subgroups do not demonstrate adequate BP control, however, and may be targets for efforts to close gaps in treatment.
Perspective:
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommended the use of thiazide diuretics as initial drug therapy for hypertension, and suggested the use of ≥2 antihypertensive agents, as indicated, to achieve goal BP control. The results of this large-scale national study demonstrate that, following publication of JNC 7 guidelines, antihypertensive medication use and BP control have increased over the past decade, likely related at least in part to antihypertensive polytherapy. Nonetheless, more than one in five hypertensive patients are not taking antihypertensive medication, and there are prominent and persistent racial disparities that warrant further action.
Keywords: Diuretics, Hispanic Americans, Health Surveys, Prevalence, Renal Insufficiency, Cardiovascular Diseases, African Continental Ancestry Group, United States, Diabetes Mellitus, Hypertension, Sodium Chloride Symporter Inhibitors
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