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Treatment Intensification for Hypertension in US Ambulatory Medical Care

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.

Methods and results: Using the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.

Conclusions: US hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

No MeSH data available.


Related in: MedlinePlus

Prevalence of hypertension treatment intensification in the United States 2005–2012.
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jah31762-fig-0001: Prevalence of hypertension treatment intensification in the United States 2005–2012.

Mentions: Among these nearly 42 million visits, treatment intensification, including medication initiation and medication addition, occurred in only 7.0 million (95% CI 6.2–7.8 million), a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion decreased from 19.3% (16.0% to 23.1%) in 2007 to a nadir of 12.3% (10.4% to 14.5%) in 2012, largely driven by a drop of hypertension medication initiation from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012 (Figure 1, P=0.014 for trend over time). The overall weighted prevalence of treatment intensification in the group without existing hypertension medication use (medication initiation) was 26.4% (24.4% to 28.5%), compared with 11.2% (10.1% to 12.4%) in the group already on hypertension medication (medication addition).


Treatment Intensification for Hypertension in US Ambulatory Medical Care
Prevalence of hypertension treatment intensification in the United States 2005–2012.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121514&req=5

jah31762-fig-0001: Prevalence of hypertension treatment intensification in the United States 2005–2012.
Mentions: Among these nearly 42 million visits, treatment intensification, including medication initiation and medication addition, occurred in only 7.0 million (95% CI 6.2–7.8 million), a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion decreased from 19.3% (16.0% to 23.1%) in 2007 to a nadir of 12.3% (10.4% to 14.5%) in 2012, largely driven by a drop of hypertension medication initiation from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012 (Figure 1, P=0.014 for trend over time). The overall weighted prevalence of treatment intensification in the group without existing hypertension medication use (medication initiation) was 26.4% (24.4% to 28.5%), compared with 11.2% (10.1% to 12.4%) in the group already on hypertension medication (medication addition).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.

Methods and results: Using the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.

Conclusions: US hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

No MeSH data available.


Related in: MedlinePlus