TY - JOUR
T1 - Use of combination antihypertensive therapy initiation in older americans without prevalent cardiovascular disease
AU - Li, Xiaojuan
AU - Camelo Castillo, Wendy
AU - Stürmer, Til
AU - Pate, Virginia
AU - Gray, Christine L.
AU - Simpson, Ross J.
AU - Setoguchi, Soko
AU - Hanson, Laura C.
AU - Funk, Michele Jonsson
N1 - Publisher Copyright:
© 2014, The American Geriatrics Society.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Objectives To describe new users of antihypertensive medications and identify predictors of combination therapy initiation in older Americans. Design Retrospective observational cohort study. Setting Population-based study using U.S. Medicare fee-for-service healthcare claims (2007-2010). Participants Medicare beneficiaries aged 65 and older with no recent diagnoses, procedures, or medications for cardiovascular disease who newly initiated an antihypertensive therapy (n = 275,493; 210,605 initiated monotherapy, 64,888 initiated combination therapy). Measurements Multivariable Poisson regression was used to assess factors associated with initiation of combination therapy versus monotherapy, including participant characteristics, prescriber characteristics, and participant encounters with the healthcare system. Results Initiation of combination therapy increased from 21.9% in 2007 to 24.7% in 2010. The most frequently initiated combinations were angiotensin-converting enzyme inhibitors with thiazide (29.7%) and angiotensin II receptor antagonists with thiazide (18.7%). Blacks (prevalence ratio (PR) = 1.48, 95% confidence interval (CI) = 1.45-1.51 vs whites), individuals seeing a generalist (PR = 1.10, 95% CI = 1.07-1.14), individuals seeing more than one doctor (PR = 3.38, 95% CI = 3.33-3.44), and participants with no pharmacy claims in the previous 6 months (PR = 1.34, 95% CI = 1.30-1.37 vs ≥3 unique drug classes) were more likely to initiate combination therapy, whereas those who had more outpatient visits in the previous 12 months were less likely to initiate combination therapy (per five visits, PR = 0.82, 95% CI = 0.80-0.83). Conclusion Nearly one in four new users of antihypertensive medications aged 65 and older started treatment with combination therapy. Blacks, individuals living in the south, and those with fewer outpatient physician office visits were more likely to initiate combination therapy. Further research is needed to determine whether this approach to managing hypertension is being well targeted to individuals who will require combination treatment.
AB - Objectives To describe new users of antihypertensive medications and identify predictors of combination therapy initiation in older Americans. Design Retrospective observational cohort study. Setting Population-based study using U.S. Medicare fee-for-service healthcare claims (2007-2010). Participants Medicare beneficiaries aged 65 and older with no recent diagnoses, procedures, or medications for cardiovascular disease who newly initiated an antihypertensive therapy (n = 275,493; 210,605 initiated monotherapy, 64,888 initiated combination therapy). Measurements Multivariable Poisson regression was used to assess factors associated with initiation of combination therapy versus monotherapy, including participant characteristics, prescriber characteristics, and participant encounters with the healthcare system. Results Initiation of combination therapy increased from 21.9% in 2007 to 24.7% in 2010. The most frequently initiated combinations were angiotensin-converting enzyme inhibitors with thiazide (29.7%) and angiotensin II receptor antagonists with thiazide (18.7%). Blacks (prevalence ratio (PR) = 1.48, 95% confidence interval (CI) = 1.45-1.51 vs whites), individuals seeing a generalist (PR = 1.10, 95% CI = 1.07-1.14), individuals seeing more than one doctor (PR = 3.38, 95% CI = 3.33-3.44), and participants with no pharmacy claims in the previous 6 months (PR = 1.34, 95% CI = 1.30-1.37 vs ≥3 unique drug classes) were more likely to initiate combination therapy, whereas those who had more outpatient visits in the previous 12 months were less likely to initiate combination therapy (per five visits, PR = 0.82, 95% CI = 0.80-0.83). Conclusion Nearly one in four new users of antihypertensive medications aged 65 and older started treatment with combination therapy. Blacks, individuals living in the south, and those with fewer outpatient physician office visits were more likely to initiate combination therapy. Further research is needed to determine whether this approach to managing hypertension is being well targeted to individuals who will require combination treatment.
KW - Medicare beneficiaries
KW - antihypertensive agents
KW - combination therapy
KW - epidemiology
KW - initial treatment
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U2 - 10.1111/jgs.12976
DO - 10.1111/jgs.12976
M3 - Article
C2 - 25112465
AN - SCOPUS:84921677577
SN - 0002-8614
VL - 62
SP - 1729
EP - 1735
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 9
ER -