Researchers from the University of Florida analyzed the use of antihypertensive drugs among patients with treatment-resistant hypertension and found “persistent infrequent use” of recommended treatments. 

Using Marketscan administrative data, the study authors analyzed trends in antihypertensive medication use from July 2008 to December 2014. Adults aged 18–65 years were included with ≥6 months of continuous enrollment, a hypertension diagnosis, and ≥1 episode of overlapping use of ≥4 antihypertensive drugs.  

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A total of 411,652 unique episodes of treatment-resistant hypertension were identified from 261,652 patients (mean age 55.9 years). During 2008 to 2014, a higher prevalence of beta-blocker (+6.8%, 79% to 85.8%) and dihydropyridine calcium antagonists (+8.1%, 69.1% to 77.2%) use was seen. A reduced prevalence of angiotensin-converting enzyme inhibitors (ACEI; -12.5%, 60.4% to 47.9) and non-dihydropyridine calcium antagonists (-5.0% , 15% to 10%) was noted. For other drug classes, the prevalence changed by <5% between 2008–2014. 

The use of thiazide diuretics was primarily unchanged from 2008–2014. Hydrochlorothiazide was the most prevalent thiazide diuretic and chlorthalidone use showed a slight +2.6% increase (3.8% to 6.4%). The use of aldosterone antagonists also showed a modest +2.9% increase (7.3% to 10.2%). 

Combined ACEI + angiotensin receptor blocker (ARB) use decreased by -11.4% (17.7% to 6.3%) but the use of optimal regimens climbed +13.8% (50.8% to 64.6%) during the study period. 

Findings from the analysis bring to attention the need for better ways to increase the use of recommended therapies for treatment-resistant hypertension including spironolactone and chlorthalidone, the authors concluded. 

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