Prevalence of Beta Blocker Prescribing for Hypertension

Background: Beta blockers are no longer recommended as first-line agents for hypertension (HTN) without compelling indications; however, evidence suggests that there is still frequent inappropriate prescribing of beta blockers to many US adults with HTN. Objective: To determine rate of prescribing of beta blockers for HTN without concurrent use of other first line antihypertensive agents. Methods: To analyze the validity of these claims, we utilized National Ambulatory Medical Care Survey data from 2013 to 2018 (excluding 2017). This data represented office visits related to adults receiving treatment for HTN. The data in the study encompasses 5191 unweighted visits representing 247 million visits nationally. Results: The data from these visits showed the prevalence of beta blocker prescribing to be 21.8% with 93.6% of beta blocker prescriptions considered inappropriate based on current guideline recommendations. This determination was made based on whether the patient had all first-line HTN treatment options prescribed prior to receiving beta blockade. Factors such as older age (≥65 years; odds ratio [OR] = 1.48, 95% CI = 1.11-1.97) and elevated blood pressure at the visit (OR = 1.43, 95% CI = 1.06-1.92) were associated with an increased likelihood of beta blocker prescribing, while depression (OR = 0.42, 95% CI = 0.24-0.73) and diabetes (OR = 0.70, 95% CI = 0.55-0.90) were associated with decreased likelihood. Conclusion: Inappropriate beta blocker prescribing for HTN without compelling indications remains highly prevalent in US outpatient practice. Older adults and patients with elevated blood pressure are particularly at risk. Targeted provider education and clinical decision support interventions are warranted to improve hypertension management.