OBJECTIVES : To investigate the use and expense of prescribed antihypertensive medicines in U.S. adults with hypertension.

METHODS : The 2014-2015 Medical Expenditure Panel Survey data were used. We assessed adult men and non-pregnant women aged 18 or older if they had a diagnosis code of hypertension and used any prescribed antihypertensive medicine (N=10,971). Adults with hypertension using a single antihypertensive medicine were classified as monotherapy users and those using two or more medicines were classified as combination therapy users. Medicines were also classified as: angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide-type diuretics (TZDs), β-blockers (BBs), and others. Covariates were age, gender, race/ethnicity, region, insurance status, marital status, education level, poverty status, smoking, and comorbidity status. Annual total antihypertensive prescription expenditures paid by all payers and expenditures of each medication class were estimated using generalized linear models with a log link and gamma distribution, and adjusted to 2015 U.S. dollars.

RESULTS : Among adults with hypertension, 4,759 (44.1%) used monotherapy and 6,212 (55.9%) used combination therapy. ACEIs were the most frequently used medicine class (n=5,196; 48.0%), followed by TZDs (n=3,869; 34.9%) and BBs (n=3,622; 33.9%). The total annual expense for prescribed antihypertensive medicines was $336 (95% confidence interval (CI)=$319-$353); $199 (95% CI=$177-$221) for monotherapy users and $436 (95% CI=$413-$459) for combination therapy users. The annual expense for each class of medicine was estimated at $438 (95% CI=$384-$492) for ARBs, $160 (95% CI=$147-$174) for CCBs, $151 (95% CI=$138-$164) for BBs, $91 (95% CI=$84-$98) for ACEIs, and $49 for TZDs (95% CI=$44-$55).

CONCLUSIONS : Combination therapy users incurred higher expense than monotherapy users. When comparing class of medicines, the expense for ARBs was the highest, while the expense for TZD was the lowest. This information can be used in evaluating the cost-effectiveness of antihypertension therapies.