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    Better control of hypertension seen in U.S. adults, study says

    Approximately half of U.S. adults (47.2%) with hypertension had achieved blood pressure (BP) control in 2010 compared to a decade earlier (28.7%) due to greater use of antihypertensive agents, according to research published in the October issue of the American Heart Association journal Circulation.

    In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) was released, recommending thiazide diuretics as initial drug therapy for most patients with uncomplicated hypertension and combination therapy from agents of different drug classes to reach BP goals, the researchers reported.

    The national guidelines recommended a goal of <130/80 mm Hg for hypertensive patients with diabetes mellitus or chronic kidney disease. All other hypertensive patients had a goal of <140/90 mm Hg.

    "The JNC 7 guidelines recommend initial combination therapy when BP is >20/10 mm Hg above goal BP. Controlled clinical trials document that ≥2 antihypertensive drugs are required for most hypertensive patients to achieve BP control," said Qiuping Gu, MD, PhD, MPH, Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, and colleagues. "However, only 36% of hypertensive individuals were actually taking multiple antihypertensive drugs in 1999 to 2002."

    More than 9,000 Americans were identified as having hypertension in the National Health and Nutrition Examination Survey (NHANES) in the last five data cycles (2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010). During the 2009 to 2010 NHANES, 77.3% of hypertensive adults reported taking antihypertensive agents to control their BP compared to 63.5% in 2001 to 2002. In addition, 47.7% in the 2009-2010 group were using multiple antihypertensive agents compared to only 36.8% in the 2001-2002 group, the researchers noted.

    "Overall, diuretics remained the most commonly used antihypertensive drug class during the 10-year period. By NHANES 2009 to 2010, more than one-third of hypertensive adults reported taking diuretics, an increase of 19% from NHANES 2001 to 2002. Use of thiazide diuretics, one of the major diuretic drug subclasses, accounted for three-fourths of all diuretic use," Dr. Gu and colleagues reported.

    The second most commonly used antihypertensive drug class during the last decade was angiotensin-converting enzyme (ACE) inhibitors. The use of ACE inhibitors increased significantly in monotherapy and polytherapy regimens. Other major drug classes that were used to control hypertension included beta-blockers, calcium-channel blockers, and angiotensin receptor blockers.

    In NHANES 2009-2010, lisinopril, an ACE inhibitor, was the most commonly used agent to control BP, followed by metoprolol (a beta-blocker) and hydrochlorothiazide (a thiazide diuretic).

    BP control results

    Researchers noted in their study that overall BP control rates increased significantly overall and across most subgroups. Overall, BP control rates climbed from 28.7% to 47.2% from 2001-2010, and among drug-treated hypertensive patients, the rates of BP control reached 60.3% from 44.6% a decade earlier.

    However, some subgroups had poor hypertension control, the researchers reported. Mexican Americans with hypertension were less likely to adhere to antihypertensive agents and less likely to take multiple agents to control their BP compared with non-Hispanic white individuals. Nonpersistence with prescribed drug therapy was almost 50% higher in Hispanics compared with other racial groups.

    Other groups that had difficulty controlling their hypertension despite the use of antihypertensive therapy included older individuals, non-Hispanic black patients, and those with diabetes mellitus or chronic kidney disease, Dr. Gu and colleagues reported.

    "In comparison with non-Hispanic white people, non-Hispanic black people had higher odds of using multiple antihypertensive drugs and thiazide diuretics, but lower odds of BP control; Mexican-American people had lower odds of using antihypertensive drugs, multiple antihypertensive drugs, and thiazide diuretics or of achieving BP control," they reported. "People with diabetes mellitus or chronic kidney disease were more likely to use antihypertensive medications but less likely to have BP control than their respective reference group."

    In addition, individuals with cardiovascular disease (CVD) did not have better BP control than individuals without CVD, despite the use of antihypertensive or multiple antihypertensive drugs.

    Hypertensive individuals who were treated with multiple-pill combinations were 26% more likely to meet the BP guidelines from JNC 7 than those receiving monotherapy. Also, those treated with single-pill combination were 55% more likely to reach their BP goals compared with monotherapy recipients.

    Julia Talsma, Content Channel Director
    Julia Talsma is lead editor for Drug Topics magazine.