Trends in Initial Combination Antihypertensive Therapy in a US Health System

Area of Science:

• Cardiology
• Public Health
• Pharmacotherapy

Background:

• Initial combination therapy is recommended for hypertension management.
• An integrated healthcare system adopted combination therapy in 2005.
• This study evaluates trends in initial combination therapy and its impact on blood pressure (BP) control.

Purpose of the Study:

• To evaluate annual trends in the utilization of initial combination therapy for hypertension.
• To assess the association between initial combination therapy and post-treatment BP control.
• To identify factors influencing the adoption and decline of combination therapy strategies.

Main Methods:

• A serial cross-sectional study of 221,384 patients initiating antihypertensive therapy (2008-2024).
• Calculated age- and sex-standardized proportions of patients starting combination therapy annually.
• Estimated prevalence ratios (PR) for achieving BP goals (<140/90 mmHg and <130/80 mmHg) with combination vs. monotherapy, adjusting for covariates.

Main Results:

• Initial combination therapy use peaked in 2011 (45%) and declined to 27% by 2024.
• The decline was consistent across all pre-treatment systolic BP levels.
• Initial combination therapy was associated with improved BP control (PRs of 1.09 for <140/90 mmHg and 1.31 for <130/80 mmHg).

Conclusions:

• Despite improved BP control, the use of initial combination therapy has decreased.
• This trend highlights a potential gap in guideline-concordant care for hypertension.
• Sustained efforts are needed to promote evidence-based combination therapy for optimal hypertension management.