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J Am Board Fam Med. 2020 Jan-Feb;33(1):143-146. doi: 10.3122/jabfm.2020.01.190134.

Anti-Hypertensive Medication Combinations in the United States.

Author information

1
From the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR). mikejoha3@gmail.com.
2
From the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR).

Abstract

BACKGROUND:

Examining the anti-hypertensive regimens of individuals with different comorbidities may offer insights into how we can improve hypertension management.

METHODS:

The Medical Expenditure Panel Survey (2013-2015) was used to describe the most common single-, two-, three-, and four-drug hypertension regimens among hypertensive adults in four different comorbidity groups: 1. Hypertension only; 2. Hypertension and diabetes; 3. Hypertension and cardiovascular disease (coronary heart disease or stroke history); and 4. Hypertension, diabetes, and cardiovascular disease.

RESULTS:

15,901 adults with hypertension taking anti-hypertensive medications were included in the study. 58.6% (95% CI: 57.3-59.8) took multiple anti-hypertensive medications, but the proportion of adults taking multiple anti-hypertensives varied by comorbidity group. Regimens including an ACE-inhibitor/ARB were the most prevalent regimens among individuals taking ≥2 anti-hypertensive medications. The most common two-drug regimen for both the hypertension-only and hypertension-diabetes groups was an ACE-inhibitor/ARB with thiazide. The most prevalent regimen for the two cardiovascular disease groups was an ACE-inhibitor/ARB with beta-blocker.

CONCLUSIONS:

Most individuals with hypertension use between 2-5 medications and the medications comprising these regimens vary by comorbidity. The ACCOMPLISH trial suggested that certain combinations may lead to superior cardiovascular outcomes. Research comparing the efficacy of different hypertension medication combinations among individuals with different comorbidities could lead to better patient hypertensionrelated outcomes.

KEYWORDS:

Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Chronic Disease; Comorbidity; Coronary Artery Disease; Disease Management; Guideline Adherence; Hypertension; Outcomes Assessment; Surveys and Questionnaires; Thiazides

PMID:
31907256
DOI:
10.3122/jabfm.2020.01.190134
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