After the 2017 ACC/AHA hypertension guidelines, angiotensin receptor blocker use increased by 8% (from 18% to 26%) with an adjusted odds ratio of 1.35 (95% CI 1.21–1.50, p < 0.0001) in US adults with treated hypertension.
Observational (n=29,901)
Sí
Does the implementation of the 2017 ACC/AHA hypertension guidelines change antihypertensive prescribing patterns in US adults with hypertension?
The 2017 ACC/AHA hypertension guidelines were associated with increased prescribing of ARBs and CCBs, but a decline in fixed-dose combination therapies, highlighting a gap between guideline recommendations and real-world practice.
Estimación del efecto: aOR 1.35 for ARB utilization post-guidelines (95% CI 1.21-1.50)
Tasa de eventos absoluta: 26% vs 18%
valor p: p=<0.0001
Background Hypertension (HTN) remains a major contributor to cardiovascular morbidity and mortality in the United States (US). The 2017 ACC/AHA HTN guidelines introduced major changes to diagnostic thresholds and treatment recommendations, including earlier pharmacological initiation and greater emphasis on combination therapy. However, the long-term, population-level impact of these guidelines on antihypertensive medication utilization in the US remains uncharacterized. Methods We conducted a pooled cross-sectional study using data from the Medical Expenditure Panel Survey (2013–2022). Adults ≥18 years with diagnosed HTN were included. Antihypertensive classes utilization was defined as any use of the medication class with ≥2 prescription refills within the same year among eligible participants. Utilization of antihypertensive classes was then pooled and examined across two periods: pre-guidelines (2013–2017) and post-guidelines (2018–2022). Survey-weighted multivariable logistic regression models were used to assess the impact of the 2017 ACC/AHA guidelines on the overall utilization of antihypertensive drug classes and within subgroups with compelling indications. Results A total of 29,901 adults were included. Following guidelines implementation, angiotensin receptor blockers (ARBs) utilization increased from 18% to 26% (adjusted OR aOR = 1.35; 95% confidence interval CI: 1.21–1.50, p 0.0001), and calcium channel blocker (CCB) use increased from 28% to 32% (aOR = 1.24; 95% CI: 1.13–1.36, p 0.0001). In contrast, fixed-dose combination (FDC) utilization declined from 22% to 16% (aOR = 0.67; 95% CI: 0.59–0.75, p 0.0001). Utilization of other antihypertensive classes did not change significantly. Conclusion After the 2017 ACC/AHA guidelines update, antihypertensive prescribing in the US showed increased use of ARBs and CCBs. However, declining FDC use highlights a persistent gap between evidence-based guidance and real-world practice.
Eissa A. Jafari (Wed,) conducted a observational in Hypertension (n=29,901). 2017 ACC/AHA hypertension guidelines implementation (effect on antihypertensive prescribing) vs. Pre-guidelines period (2013–2017) was evaluated on Annual utilization of antihypertensive medication classes (aOR 1.35 for ARB utilization post-guidelines, 95% CI 1.21-1.50, p=<0.0001). After the 2017 ACC/AHA hypertension guidelines, angiotensin receptor blocker use increased by 8% (from 18% to 26%) with an adjusted odds ratio of 1.35 (95% CI 1.21–1.50, p < 0.0001) in US adults with treated hypertension.