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Anti-Hypertensive Medication Combinations in the United States
Michael E Johansen1, Jonathan Yun2, James M Griggs2
1From 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.
Insights
Most adults with hypertension use multiple medications, with common drug combinations varying by comorbidity. Understanding these patterns can improve hypertension management and patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension management is complex and influenced by comorbidities.
- Understanding current anti-hypertensive medication regimens is crucial for optimizing treatment.
Purpose of the Study:
- To describe common anti-hypertensive medication regimens in adults with hypertension.
- To analyze these regimens across four distinct comorbidity groups.
Main Methods:
- Utilized data from the Medical Expenditure Panel Survey (2013-2015).
- Included 15,901 adults with hypertension on anti-hypertensive medications.
- Categorized participants into four groups based on comorbidities: hypertension only, hypertension and diabetes, hypertension and cardiovascular disease, and all three.
Main Results:
- Over half (58.6%) of adults with hypertension used multiple anti-hypertensive medications.
- Regimens with angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) were most common for multi-drug therapies.
- Specific two-drug combinations varied: ACE-inhibitor/ARB with thiazide for hypertension-only and hypertension-diabetes groups; ACE-inhibitor/ARB with beta-blocker for cardiovascular disease groups.
Conclusions:
- Hypertension medication regimens, often involving 2-5 drugs, differ significantly based on patient comorbidities.
- Further research into the efficacy of specific combination therapies for diverse patient groups is warranted.
- Optimizing anti-hypertensive regimens tailored to comorbidities may improve patient outcomes.
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.
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