Initial combination antihypertensive therapy decreased from 45% in 2011 to 27% in 2024 despite being associated with improved BP control (PR 1.09 for <140/90 mm Hg).
Does initial combination antihypertensive therapy improve blood pressure control compared to monotherapy in patients newly initiating treatment?
Initial combination antihypertensive therapy is associated with improved blood pressure control compared to monotherapy, yet its use in a large US health system has significantly declined from 45% in 2011 to 27% in 2024.
Absolute Event Rate: 0% vs 0%
Abstract Background Initial combination therapy has been recommended for patients with high blood pressure (BP). We evaluated annual trends in initial combination therapy and post-treatment BP in Kaiser Permanente Southern California, an integrated healthcare system that adopted combination therapy in 2005 Methods This serial cross-sectional study included patients newly initiating antihypertensive therapy from 2008 to 2024. We calculated annual age- and sex-standardized proportion of patients initiating combination therapy. Prevalence ratios (PR) of achieving post-treatment BP 140/90 and 130/80 mm Hg between 6 and 12 months were estimated for initial combination versus monotherapy adjusting for demographic and pre-treatment BP. Results Among 221,384 patients, the use of initial combination therapy increased from 39% in 2008 to 45% in 2011 (p-trend=0.009), then decreased to 27% in 2024 (p-trend 0.001). The decreasing trend of initial combination therapy from 2011 to 2024 was consistent across all pre-treatment systolic BP levels: 130-139 mm Hg (33% to 20%), 140-149 mm Hg (42% to 22%), 150-159 mm Hg (49% to 29%), and ≥160 mm Hg (61% to 36%). Post-treatment BP 140/90 mm Hg was 75% in 2011 and 66% in 2024; BP 130/80 mm Hg was 35% in 2011 and 25% in 2024. PRs for initial combination versus monotherapy were 1.09 (95% CI 1.08, 1.10) for post-treatment BP 140/90 mm Hg and 1.31 (95% CI 1.29, 1.33) for 130/80 mm Hg. Conclusions Although initial combination therapy remains associated with improved BP control, its use has declined in recent years, underscoring the importance of sustained support for guideline concordant care.
An et al. (Tue,) reported a other. Initial combination antihypertensive therapy decreased from 45% in 2011 to 27% in 2024 despite being associated with improved BP control (PR 1.09 for <140/90 mm Hg).