Several deviations were observed between recommendations put forth by evidence-based guidelines for hypertension management and real-world clinical utilization patterns of antihypertensive agents, according to the findings of a recent observational retrospective study.

The aim of the study was to analyze antihypertensive utilization patterns among patients with uncontrolled hypertension despite receiving therapy. “Through this investigation, we aim to contribute to the body of evidence that evaluates how prescribers are following the evidence-based guidelines for hypertension management,” the authors explained.

The study authors obtained data from the Decision Resources Group Real World Evidence Data Repository US database (2015-2016) to develop a cohort of patients with uncontrolled hypertension in order to analyze antihypertensive utilization patterns. Since data from 2015 to 2016 was used in their analysis, the study authors compared utilization patterns to recommendations put forth in the Eighth Joint National Committee (JNC 8) guidelines.

A total of 5059 patients were included in the analysis. The average age of the patients was reported to be 57.8 years (SD, 13.7); 51.9% of the patients were female and 86.8% were white. Additionally, 37.1% of patients in the study were reported to have diabetes mellitus (DM) or chronic kidney disease (CKD), which could possibly contribute to an increased prevalence of cardiovascular complications independently.

Results of the analysis found that patients in the cohort were prescribed 2.4 medications on average. “Overall, the most common treatments prescribed, as percent of agents and as percent of patients, respectively, were diuretics (24.9%; 59.6%), followed by angiotensin-converting enzyme inhibitors (ACEIs) (23.8%; 56.9%), beta-blockers (BBs) (18.7%; 44.8%), calcium channel blockers (CCBs) (15.4%; 36.8%), and angiotensin II receptor blockers (ARBs) (13.5%; 32.3%),” the study authors stated. Additionally, the authors noted that the order of most common medications prescribed was the same for patients with DM and CKD (n=200).

Findings of the study also revealed that 10.5% of prescriptions written were for fixed-dose combination therapies. Furthermore, data analysis found that only 5.6% of prescriptions written for patients with DM and CKD were for fixed-dose combination therapies.

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“Based on clinical guidelines, which suggest using ACEIs, ARBs, or CCBs as first-line therapy, and fixed-dose combination therapy to increase adherence, this indicates over-prescribing of BBs and under-prescribing of fixed-dose combination therapy,” the study authors concluded. They added that further research into the barriers and challenges affecting treatment decision-making by both patients and providers was needed in order to promote better management of uncontrolled hypertension.


LaVallee C, Rascati KR, Gums TH. Antihypertensive agent utilization patterns among patients with uncontrolled hypertension in the United States [published online September 20, 2020]. J Clin Hypertens. 2020;00:1–9. doi: 10.1111/jch.14041.