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(Hypertension. 2009;53:617.)
© 2009 American Heart Association, Inc.

Original Articles

Antihypertensive Prescriptions for Newly Treated Patients Before and After the Main Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Results and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines

Paul Muntner; Marie Krousel-Wood; Amanda D. Hyre; Erin Stanley; William C. Cushman; Jeffrey A. Cutler; Linda B. Piller; Gary A. Goforth; Paul K. Whelton

From the Department of Community and Preventive Medicine (P.M.), Mount Sinai School of Medicine, New York, NY; Ochsner Clinic Foundation and Tulane University Schools of Medicine and Public Health and Tropical Medicine (M.K-W., E.S.), New Orleans, La; University of Pennsylvania School of Medicine (A.D.H.), Philadelphia; Memphis Veterans Affairs Medical Center (W.C.C.), Memphis, Tenn; National Heart, Lung, and Blood Institute (J.A.C.), Bethesda, Md; University of Texas Health Science Center School of Public Health (L.B.P.), Houston; Montgomery Center for Family Medicine (G.A.G.), Greenwood, SC; and Loyola University Medical Center (P.K.W.), Maywood, Ill.

Correspondence to Paul Muntner, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10016. E-mail paul.muntner{at}mssm.edu

Main results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial were published in December 2002. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, published in May 2003, recommended thiazide-type diuretics as initial pharmacological treatment alone or in combination with another drug in most patients with hypertension. To assess changes from before to after these publications, we compared antihypertensive medication prescriptions filled by patients who initiated pharmacological antihypertensive treatment in a large managed care organization during 3 time periods: (1) July 1, 2001, to June 30, 2002 (before these publications; n=1354); (2) July 1, 2003, to June 30, 2004 (to assess short-term changes; n=1542); and (3) July 1, 2004, to June 30, 2005 (to assess extended changes; n=1865). The percentage of patients initiating antihypertensive treatment with a thiazide-type diuretic increased from 30.6% to 39.4% (P<0.001) between 2001–2002 and 2003–2004, and the increase was maintained at 36.5% in 2004–2005 (P<0.001 compared with 2001–2002 and P=0.33 compared with 2003–2004). Among patients without diabetes mellitus, renal disease, a history of myocardial infarction, or heart failure, the percentage initiating pharmacological antihypertensive treatment with a thiazide-type diuretic increased from 33.1% in 2001–2002 to 43.4% in 2003–2004 (P<0.001) and remained increased (41.0%) in 2004–2005 (P<0.001 and P=0.23 compared with 2001–2002 and 2003–2004, respectively). Despite a sustained increase in the use of thiazide-type diuretics, this study indicates that an opportunity exists to increase adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines.

Key Words: hypertension • antihypertensive agents • thiazide diuretics • clinical trials • epidemiology

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