National Trends in the Ambulatory Treatment of Hypertension in the United States, 1997-2012

Abstract

ImportanceHypertension is common and costly. Over the past decade, new antihypertensive therapies have been developed, several have lost patent protection and additional evidence regarding the safety and effectiveness of these agents has accrued.ObjectiveTo examine trends in the use of antihypertensive therapies in the United States between 1997 and 2012.Design, Setting and ParticipantsWe used nationally representative audit data from the IMS Health National Disease and Therapeutic Index to examine the ambulatory pharmacologic treatment of hypertension.Outcome MeasuresOur primary unit of analysis was a visit where hypertension was a reported diagnosis and treated with a pharmacotherapy (treatment visit). We restricted analyses to the use of six therapeutic classes of antihypertensive medications among individuals 18 years or older.ResultsAnnual hypertension treatment visits increased from 56.9 million treatment visits (95% confidence intervals [CI], 53.9–59.8) in 1997 to 83.3 million visits (CI 79.2–87.3) in 2008, then declined steadily to 70.9 million visits (CI 66.7–75.0) by 2012. Angiotensin receptor blocker utilization increased substantially from 3% of treatment visits in 1997 to 18% by 2012, whereas calcium channel blocker use decreased from 27% to 18% of visits. Rates of diuretic and beta-blocker use remained stable and represented 24%–30% and 14–16% of visits, respectively. Use of direct renin inhibitor accounted for fewer than 2% of annual visits. The proportion of visits treated using fixed-dose combination therapies increased from 28% to 37% of visits.ConclusionsSeveral important changes have occurred in the landscape of antihypertensive treatment in the United States during the past decade. Despite their novel mechanism of action, the adoption rate of direct renin inhibitors remains low.

Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011

“…Although our investigation was not designed to determine the specific causes of changes that we identify, several contributing factors may account for increases we observed, including the implementation of Medicare Part D, 10,34 changes to clinical guidelines, 35,36 and market dynamics, such as new therapies brought to market as well as patent expirations. 13,37–40 …”

Structural Changes and Evolution of Peptides During Chill Storage of Pork

“…Eighteen peptides were estimated to have ACE-inhibitory and DPPIV inhibitory activities, which have been identified in the database (26). ACE inhibitors are known to beneficial to treat arterial hypertension (27), diabetes mellitus, ischemic heart disease, chronic heart failure, angioedema, chronic kidney disease, and Parkinson's disease (28,29). DPPIV inhibitor may be beneficial for NASH subjects (30).…”

Effect of Renin-Angiotensin System Inhibitors on the Comparative Nephrotoxicity of NSAIDs and Opioids during Hospitalization

“…This represents a critical knowledge gap: if NSAID+RAS-I is truly nephrotoxic in this setting, the combination may contribute substantially to AKI and associated downstream effects including chronic kidney disease (20); if not, withholding such therapy may unnecessarily expose patients to opioids, with corresponding risks of adverse drug events (22) and long term opioid use and abuse syndromes (23,24). The potential impact on global kidney disease burden is substantial, given that approximately 15-20 million patients receive analgesia during hospitalization each year (22,25), and RAS-I are the most commonly used antihypertensives (26). We thus aimed to determine whether NSAID+RAS-I treatment has synergistic effects on AKI rates in hospitalized patients.…”