Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018

Background: Hypertension control has worsened nationally, and treatment intensification is important for control. National trends for appropriate blood pressure intensification for older adults are unknown. We determine the proportion of ambulatory visits where older adults with hypertension were appropriately intensified on antihypertensives from 2008 to 2018. Methods: Data from National Ambulatory Medical Care Survey were used. National Ambulatory Medical Care Survey is a nationally representative sample of ambulatory visits. Adults 60 years or older were included. Appropriate antihypertensive intensification was defined as addition of an antihypertensive for a blood pressure reading above target. We examined appropriate intensification by blood pressure targets set by the American College of Cardiology–American Heart Association, the European Society of Cardiology, and the American College of Physicians–American Academy of Family Physicians guidelines for older adults. Further, we defined an additional all-inclusive criterion meeting all 3 guidelines. Results: From 2008 to 2018, appropriate intensification by American College of Cardiology/American Heart Association occurred at 11.1% (95% CI, 9.8%–12.5%) of visits, decreasing from 13.6% (95% CI, 15.6%–28.7%) of visits in 2008 to 2009 to 10.4% (95% CI, 10.9%–26.4%) in 2015 to 2018. Appropriate intensification by European Society of Cardiology occurred at 14.2% (12.1%–16.6%) of visits over 2008 to 2018, decreasing from 16.9% (95% CI, 13.5%–21.0%) in 2008 to 2009 to 12.5% (95% CI, 7.4%–20.3%) from 2015 to 2018. Appropriate intensification by American Academy of Family Physicians/American College of Physicians occurred at 18.9% (16.2%–22.0%) of visits over 2008 to 2018, decreasing from 24.7% (95% CI, 20.2%–29.0%) in 2008 to 2009 to 14.9% (95% CI, 9.0%–23.7%) from 2015 to 2018. By all-inclusive criteria, intensification trended toward worsening with time: odds ratio: 0.93 ([95% CI, 0.87–1.00]; P =0.07). Conclusions: Appropriate treatment intensification for older adults with hypertension in the United States was suboptimal over the past decade.