OBJECTIVES: Hypertension affects roughly one out of every three adults and contributes to approximately 1,000 deaths per day United States. This study investigated the landscape of antihypertensives utilized among patients, with health insurance, who have been diagnosed with hypertension, received pharmaceutical treatment, and still experienced uncontrolled hypertension.

METHODS: Data were obtained from the Decision Resources Group Real World Evidence Data Repository US database. Using the ICD-9-CM and ICD-10-CM codes and clinical lab values to define a cohort of uncontrolled hypertension patients. Defined by SBP>140 mmHg or DBP>90 mmHg for hypertension between Q1-2015 and Q4-2016. Univariate descriptive statistics, including means, standard deviations, and proportions were calculated for study variables.

RESULTS: The study cohort consisted of 5,067 patients, with an average age of 57.8 and 51.9% female. Patients were mostly Caucasian (86.8%), with 11% African American, and 1.3% Latino. The mean number of antihypertensives prescribed over the observation period was 2.6 (sd=1.4), with 42.3% of patients only receiving one agent, 29.3% of patients only receiving two agents, and 28.4% receiving three or more agents. Among the written prescriptions, we found that 10.5% were for combination therapies. Overall, the most common treatment class observed in this cohort were diuretics (24.9%), followed by ACE inhibitors (23.8%), beta blockers (18.7%), CCB (15.4%), ARB (13.5%), centrally acting antihypertensives (2.1%), aldosterone antagonists (1.5%). Direct renin inhibitors and ARNI were utilized less than 1% each respectively.

CONCLUSIONS: This study demonstrates an overuse of beta-blockers and an underutilization of combination therapy. These findings illustrate the need to further investigate understanding of the barrier that both patients and providers face in treatment decision making.