Age Differences in Treatment and Control of Hypertension in US Physician Offices, 2003-2010: A Serial Cross-sectional Study

Abstract

Background: Evidence-based and age-appropriate antihypertensive pharmacotherapy in outpatient settings is essential for optimal treatment outcomes. Recent guidelines, although controversial, recommended different blood pressure goals using age cutoff of 60 years. We describe recent age-specific national trends in antihypertensive prescribing patterns and blood pressure control in US office-based practices.

Methods: We analyzed all hypertension-related visits to physician offices from the latest available National Ambulatory Medical Care Survey (2003-2010). We identified trends of antihypertensive prescribing overall and by class, trends of hypertension control, age differences in antihypertensive prescribing patterns and hypertension control, predicted probabilities of hypertension control in subgroups, and correlates of hypertension control.

Results: There were 16,729 physician office visits included in the analysis. Overall, the prescription of antihypertensive medication increased from 69.2% in 2003-2004 to 78.8% in 2009-2010 (Ptrend = .001), and the increased trend was consistent in both age groups (<60 and ≥60 years). This was accompanied by an improvement in the overall hypertension control (from 39.1% to 48.8%, Ptrend <.001). Antihypertensive prescribing patterns differ significantly between the 2 age groups. The proportions of visits with β-blocker (from 25.4% to 34.7%, Ptrend <.001) and angiotensin receptor blocker prescriptions (from 17.0% to 22.1%, Ptrend = .042) increased for older patients. The increased trend of β-blocker use persisted after excluding patients with compelling indications. Among treated patients, lower odds of blood pressure control were associated with African American race, presence of comorbidities, younger age, and insufficient insurance coverage.

Conclusions: In office-based practices, antihypertensive medication prescribing among US adults with hypertension increased significantly in recent years, which was accompanied by improvement in hypertension control. The prescribing patterns differed among younger and older patients, but continuous use of β-blockers without other compelling indications raises concerns.

Keywords: Aged; Antihypertensive therapy; Hypertension; Hypertension control.