ArticleJournal of general internal medicine2022
National Trends in Antihypertensive Treatment Among Older Adults by Race and Presence of Comorbidity, 2008 to 2017.
Article in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 14 citations in OpenAlex.
- Fixed-Dose Combinations for Hypertension: Barriers to Use and Opportunities for Health Systems.Journal of clinical hypertension (Greenwich, Conn.) · 2026Article
- Factors associated with angiotensin II stimulating vs. inhibiting antihypertensive drug use in older adults.BMC geriatrics · 2026Article
- Addressing Hypertension Treatment Disparities Via Renal Denervation.Current hypertension reports · 2026Review
- Optimizing Care for Cardiovascular-Kidney-Metabolic Syndrome: Leveraging Implementation Science in the Path Toward Pharmacoequity.Current cardiology reports · 2025Review
- First-Line β-Blocker Use for Hypertension in the Veterans Health Administration.JAMA network open · 2025Article
- Use and Cost Patterns of Antihypertensive Medications in the United States From 1996 to 2021.Hypertension (Dallas, Tex. : 1979) · 2024Article
- Factors associated with fall risk increasing drug use in older black and white men and women: the Health ABC Study.BMC geriatrics · 2024Article
- Brief communication: temporal trends of chronic diseases medications prescriptions among HIV-infected patients in Belgium: a 4-year population-based study using pharmacy claims data.AIDS research and therapy · 2024Article
- Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records.Journal of the American Heart Association · 2024Article
- Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network.Journal of the American Heart Association · 2023Article
- Getting Under the Skin: Race-Based Guidelines and the Pursuit of Pharmacoequity.Journal of general internal medicine · 2022Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundIn 2014, hypertension guidelines for older adults endorsed increased use of fixed-dose combinations, prioritized thiazide diuretics and calcium channel blockers (CCBs) for Black patients, and no longer recommend beta-blockers as first-line therapy.
objectiveTo evaluate older adults' antihypertensive use following guideline changes.
designTime series analysis. PATIENTS: Twenty percent national sample of Medicare Part D beneficiaries aged 66 years and older with hypertension.
interventionEighth Joint National Committee (JNC8) guidelines MAIN MEASURES: Quarterly trends in prevalent and initial antihypertensive use were examined before (2008 to 2013) and after (2014 to 2017) JNC8. Analyses were conducted among all beneficiaries with hypertension, beneficiaries without chronic conditions that might influence antihypertensive selection (hypertension-only cohort), and among Black patients, given race-based guideline recommendations. KEY
resultsThe number of beneficiaries with hypertension increased from 1,978,494 in 2008 to 2,809,680 in 2017, the proportions using antihypertensives increased from 80.3 to 81.2%, and the proportion using multiple classes and fixed-dose combinations declined (60.8 to 58.1% and 20.7 to 15.1%, respectively, all P<.01). Prior to JNC8, the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and CCBs was increasing. Use of CCBs as initial therapy increased more rapidly following JNC8 (relative change in quarterly trend 0.15% [95% CI, 0.13-0.18%), especially among Black beneficiaries (relative change 0.44% [95% CI, 0.21-0.68%]). Contrary to guidelines, the use of thiazides and combinations as initial therapy consistently decreased in the hypertension-only cohort (13.8 to 8.3% and 25.1 to 15.7% respectively). By 2017, 65.9% of Black patients in the hypertension-only cohort were initiated on recommended first-line or combination therapy compared to 80.3% of non-Black patients.
conclusionsMany older adults, particularly Black patients, continue to be initiated on antihypertensive classes not recommended as first-line, indicating opportunities to improve the effectiveness and equity of hypertension care and potentially reduce antihypertensive regimen complexity.
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