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Trend in Blood Pressure Control Post Antihypertensive Drug Initiation in the U.S.

Published:December 30, 2021DOI:https://doi.org/10.1016/j.amepre.2021.10.015

      Introduction

      The aim of this study is to evaluate the temporal trends in systolic blood pressure control over 18 months after blood pressure‒lowering drug initiation in the U.S. population.

      Methods

      From U.S. nationally representative electronic health records, 1,036,775 adults initiating and continuing blood pressure‒lowering drugs for ≥18 months during 2006–2018 were identified (January 2021). Prevalence trends of cardiovascular disease, diabetes, and depression at blood pressure‒lowering drug initiation, blood pressure‒lowering drug therapy intensification over 18 months, and the adjusted probability of achieving systolic blood pressure control 6 months after baseline and sustaining the control for over 18 months were evaluated.

      Results

      At blood pressure‒lowering drug initiation, the prevalence of diabetes and depression consistently increased during the study period across all age groups, particularly in those aged 18–49 years, whereas the prevalence of cardiovascular disease was stable. Adjusted probabilities of achieving sustainable systolic blood pressure control by age group were 0.62 (95% CI=0.61, 0.63) for ages 18–39 years, 0.55 (95% CI=0.55, 0.56) for ages 40–49 years, 0.50 (95% CI=0.49, 0.50) for ages 50–59 years, 0.43 (95% CI=0.42, 0.43) for ages 60–69 years, and 0.37 (95% CI=0.37, 0.38) for ages 70–80 years. Those with cardiovascular disease or cardiovascular disease and diabetes had approximately 20% lower adjusted probability of achieving systolic blood pressure control (31%/29%) than those without these conditions (52%, p<0.01). Those with depression had a 4% higher probability of systolic blood pressure control than those without the condition (49% vs 45%, p<0.01).

      Conclusions

      In the U.S., only 30%–50% of the population are achieving sustainable blood pressure control over 18 months after blood pressure‒lowering drug initiation, with no indication of improvement in control over the last decade.
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