Trends in antihypertensive drug use in the United States: do the JNC V recommendations affect prescribing? Fifth Joint National Commission on the Detection, Evaluation, and Treatment of High Blood Pressure

CONTEXT: The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications. OBJECTIVES: To describe national antihypertensive medication prescribing patterns for 1992 and 1995; to explore the influence of the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V), published in 1993, which recommended diuretics and beta-blockers as first-line antihypertensive therapy unless contraindicated; and to estimate the impact of these prescribing patterns on the cost of antihypertensive treatment. DESIGN: All prescriptions for drugs approved for the treatment of hypertension dispensed by 35000 retail pharmacies were tabulated for 1992 and 1995 (62% of all US retail pharmacies were surveyed). MAIN OUTCOME MEASURES: Number of prescriptions for each dosage form of medication and national cost estimates based on wholesale costs of medications dispensed. RESULTS: In 1992, of the 10 most frequently prescribed antihypertensive drugs, 3 were calcium antagonists, 3 were angiotensin-converting enzyme (ACE) inhibitors, 3 were beta-blockers, and 1 was the combination of triamterene and hydrochlorothiazide. In 1995, 4 were calcium antagonists, 3 were ACE inhibitors, 1 was a beta-blocker, 1 was the combination of triamterene and hydrochlorothiazide, and 1 an alpha-blocker. In 1992, calcium antagonists accounted for 33% of antihypertensive prescriptions compared with 38% in 1995, ACE inhibitor use went from 25% to 33%, beta-blocker use from 18% to 11%, and diuretic use from 16% to 8%. The estimated wholesale costs for calcium antagonists in 1995 dollars increased from 2. 67 billion in 1992 to 2. 86 billion in 1995; ACE inhibitor costs increased from 1. 37 billion to 1. 67 billion; costs for diuretics declined from 353 million to 168 million; and costs for beta-blockers declined from 763 million to 433 million. CONCLUSIONS: From 1992 to 1995 use of calcium antagonists and ACE inhibitors for treatment of hypertension increased and diuretics and beta-blockers declined, suggesting that the recommendations from JNC V had little effect on prescribing patterns. The cost implications of these practice patterns are enormous.