Trends in Antihypertensive Medication Use Among US Patients With Resistant Hypertension, 2008 to 2014
Open accessAbstract
Little is known of US trends in antihypertensive drug use for patients with treatment-resistant hypertension (TRH). We analyzed antihypertensive use among patients with TRH (treated with ≥4 antihypertensive drugs concurrently) from July 2008 through December 2014 using Marketscan administrative data. We included adults aged 18 to 65 years, with ≥6 months of continuous enrollment, a hypertension diagnosis, and ≥1 episode of overlapping use of ≥4 antihypertensive drugs; patients with heart failure were excluded. We identified 411 652 unique TRH episodes from 261 652 patients with a mean age of 55.9 years. From 2008 to 2014, we observed an increased prevalence, among TRH episodes, of β-blockers (+6.8% [79% to 85.8%]) and dihydropyridine calcium antagonists (+8.1% [69.1% to 77.2%]), and a decreased prevalence of angiotensin-converting enzyme inhibitors (−12.5% [60.4% to 47.9%]) and nondihydropyridine calcium antagonists (−5.0% [15% to 10%]). The prevalence of most other classes changed by <5% from 2008 to 2014. Thiazide diuretic use was largely unchanged from 2008 to 2014, with hydrochlorothiazide being by far the most prevalent thiazide diuretic; chlorthalidone use increased only modestly (+2.6% [3.8% to 6.4%]). Aldosterone antagonist use increased only modestly (+2.9% [7.3% to 10.2%]). Use of optimal regimens increased steadily (+13.8% [50.8% to 64.6%]) during the study period, whereas combined angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use declined (−11.4% [17.7% to 6.3%]). Our results highlight the persistent infrequent use of recommended therapies in TRH, including spironolactone and chlorthalidone, and suggest a need for better efforts to increase the use of such approaches in light of recent evidence demonstrating their efficacy.
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Drug treatment regimens in resistant hypertension infrequently include either spironolactone or chlorthalidone, 2 highly effective blood pressure-lowering agents, in this high-risk group of hypertensives.
“Accordingly, drug treatment regimens in RH infrequently include either spironolactone or chlorthalidone, 2 highly effective BP-lowering agents, in this high-risk group of hypertensives.60,61”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [60]
Suboptimal antihypertensive drug regimens substantively contribute to the likelihood of being diagnosed with resistant hypertension.
“Suboptimal antihypertensive drug regimens substantively contribute to the likelihood of being diagnosed with RH.41,60,61”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [60]
Suboptimal medication regimens are common in patients with hypertension resistant to antihypertensive therapy.
“Suboptimal medication regimens are common in patients with hypertension resistant to antihypertensive therapy.21,60,367”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [60]
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- Authors
- Hwang, A. Y., Dave, C., & Smith, S. M.
- Affiliations
- University of Florida Health (US)
- Venue
- Hypertension
- Published
- 2016-12
- Volume
- 68
- Issue
- 6
- Pages
- 1349-1354
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2536697423
- Cited by
- 54
- References
- 31
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 5 · 2022: 9 · 2021: 6 · 2020: 9 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 1
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- resistant hypertension, antihypertensive medication use, treatment-resistant hypertension, drug use trends, beta-blockers, dihydropyridine calcium antagonists, ACE inhibitors, thiazide diuretics, mineralocorticoid receptor antagonists, spironolactone, chlorthalidone
- MeSH terms
- Adult, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure Determination, Calcium Channel Blockers, Chlorthalidone, Drug Resistance, Drug Therapy, Combination, Drug Utilization, Female, Follow-Up Studies, Humans, Hydrochlorothiazide, Hypertension, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Spironolactone, United States, Cohort Studies, Treatment Outcome, Risk Assessment, Patient Safety
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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