Fixed‐Dose Combination Medication Use Among US Adults With Hypertension: A Missed Opportunity

lood pressure (BP) control rates in the United States have been decreasing since 2013.1,2 In response, the US Surgeon General issued a Call to Action to Control Hypertension in 2020, naming BP control a national priority.3 In the call to action and the 2017 American College of Cardiology/American Heart Association BP guidelines, one strategy to optimize patient care is the use of simplified medication regimens, including fixed-dose combination (FDC) products, which can improve medication adherence and prevent therapeutic inertia.3-5 However, both the degree to which FDCs have been adopted in clinical practice over time and the association with these trends and declining BP control rates are unclear.This analysis examined FDC antihypertensive medication use in US adults using multiple classes of BP-lowering medications from 2009 to 2020, patient characteristics associated with FDC use, and the association between FDC use and BP control rates.We examined data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2012, 2013 to 2016, and 2017 to 2020 (prepandemic) cycles.NHANES provides deidentified, publicly available data that can be accessed at https://www.cdc. gov/nchs/nhane s/.All NHANES participants provided written informed consent.Institutional review board review was not required for this analysis.We included adult participants (aged ≥20 years) with hypertension (ie, systolic BP/diastolic BP ≥140/90 mm Hg or using ≥1 antihypertensive medication).To identify those who potentially could be using at least 1 FDC, we further restricted the sample to those taking ≥2 different classes of antihypertensives.The number of antihypertensive medication classes and FDC use were identified from self-reported prescription medication use or pill bottle review.Participants' 3 BP measurements were averaged, and controlled BP was defined as mean systolic BP/diastolic BP <140/90 mm Hg.NHANES changed to oscillometric measurement of BP in the 2017 to 2020 cycle.As in prior analysis, we added 1.5 mm Hg to systolic BP and subtracted 1.3 mm Hg from diastolic BP oscillometric measurements to approximate auscultatory BP measurements in prior NHANES cycles. 2 Age-adjusted proportions of individuals using FDC medications were estimated separately across each NHANES cycle.Multivariable logistic regression was used to examine age-adjusted trends in FDC use over time, predictors of FDC use, BP control over time, and BP control by FDC use.All models were adjusted for age, sex, race and ethnicity, education, marital status, having