Guideline-directed antihypertensive medication use among young adult participants with uncontrolled hypertension at enrollment in the MyHEART study.

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Clinical Guidelines
Authored By
Knutson Sinaise MR, Zaborek J, Kim K, Lauver DR, McBride P, Pearson J, Licon A, Joseph A, Johnson HM, Hoppe KK
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Interests
Cardiology
Internal/Family Medicine
Speciality
Cardiology
Internal/Family Medicine
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volume
24
ISSN
1471-2261
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ISSN
1471-2261 ; Electronic
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true
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Additional Info
["Knutson Sinaise MR, Zaborek J, Kim K, Lauver DR, McBride P, Pearson J, Licon A, Joseph A, Johnson HM, Hoppe KK","Publisher: BioMed Central Country of Publication: England NLM ID: 100968539 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2261 (Electronic) Linking ISSN: 14712261 NLM ISO Abbreviation: BMC Cardiovasc Disord Subsets: MEDLINE","Journal Article; Multicenter Study; Randomized Controlled Trial","2024-11-13","BMC cardiovascular disorders [BMC Cardiovasc Disord] 2024 Nov 13; Vol. 24 (1), pp. 636. Date of Electronic Publication: 2024 Nov 13.","English","1471-2261","Antihypertensive Agents*\/therapeutic use , Blood Pressure*\/drug effects , Guideline Adherence* , Hypertension*\/drug therapy , Hypertension*\/diagnosis , Hypertension*\/physiopathology , Hypertension*\/epidemiology , Practice Guidelines as Topic* , Practice Patterns, Physicians'*, Adult ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Age Factors ; Cross-Sectional Studies ; Drug Prescriptions ; Drug Therapy, Combination ; Retrospective Studies ; Treatment Outcome ; United States\/epidemiology","Adult, Female, Humans, Male, Middle Aged, Young Adult, Age Factors, Cross-Sectional Studies, Drug Prescriptions, Drug Therapy, Combination, Retrospective Studies, Treatment Outcome, United States epidemiology, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Guideline Adherence, Hypertension drug therapy, Hypertension diagnosis, Hypertension physiopathology, Hypertension epidemiology, Practice Guidelines as Topic, Practice Patterns, Physicians'","BMC cardiovascular disorders","24"]
Description
Background: Hypertension is a major risk factor for heart disease, heart failure and stroke. Lifestyle changes are recommended as first-line treatment for management of high blood pressure for young adults, when 10-year atherosclerotic cardiovascular disease risk score is &lt; 10%. If lifestyle changes alone do not control blood pressure, then providers have access to four classes of first-line blood pressure lowering agents to treat hypertension, when other contra-indications are not present.<br />Methods: This is a cross-sectional, retrospective, secondary analysis performed of the MyHEART trial on study participants at enrollment to determine they were prescribed anti-hypertensive medication. Of those prescribed medications, we aimed to determine the frequency first-line medications including thiazide or thiazide-like diuretics, angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers were prescribed. This analysis categorized participants into four medication status categories: no antihypertensive medication, prescribed only first-line antihypertensives, prescribed only non-first-line antihypertensives, and prescribed a combination of first-line and non-first-line antihypertensives. Participant clinical and sociodemographic factors by medication use were evaluated. Linear regression models were fit to determine the association between antihypertensive medication and blood pressure.<br />Results: At enrollment, 157/311 (50.5%) participants were not on antihypertensives. Of the 154 on antihypertensives, reported use included monotherapy 97/154 (63.0%), combined therapy 57/154 (37.0%), only first-line antihypertensive 111/154 (72.0%), and only non-first-line antihypertensives 21/154 (13.6%), and combination of first-line and non-first-line antihypertensives 22/154 (14.2%). Antihypertension medication use varied based on age (p &lt; 0.001), sex (p = 0.008), race (p = 0.001), body mass index (BMI) kg/m <superscript>2</superscript> (p = 0.016), anxiety and/or depression (p = 0.048), diabetes (p = 0.007), and sodium intake (p = 0.042). Participants with only first-line medications had lower in-office systolic (-4.66 mmHg, CI -8.31 to -1.02, p = 0.013) and diastolic (-3.51 mmHg, CI -6.30 to -0.71, p = 0.015), and lower ambulatory diastolic (-2.12 mmHg, CI -4.15 to -0.09, p = 0.041) blood pressure than those without antihypertensives.<br />Conclusions: Among MyHEART study participants, all of which had uncontrolled hypertension, 50.5% were not on an antihypertensive at enrollment. This finding supports the call to improve management of blood pressure earlier in life to potentially contribute to the reduction of long-term cardiovascular disease. Of the participants who were prescribed blood pressure medication, providers prescribed guideline-based antihypertensive therapy the majority of the time, however, this study indicates there may be an opportunity to increase the use of first-line, guideline-based antihypertensives, regardless of age, sex, or type of hypertension to lower long-term cardiovascular risk.<br />Trial Registration: https://www.<br />Clinicaltrials: gov Identifier: NCT03158051, registered 5-15-2017. IRB approval obtained: IRB # 2017 - 0372.<br /> (© 2024. The Author(s).)
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