Trends in Pediatric Blood Pressure-Lowering Prescription Fills During 2017-2023

Abstract

Introduction: There are no national estimates for blood pressure-lowering prescription trends among the U.S. pediatric population. This study describes trends in blood pressure-lowering prescription fills among individuals aged 3-17 years by sex and age group.

Methods: Data were obtained from IQVIA's Total Patient Tracker database covering 94% of all outpatient retail prescription fills in the U.S. The key outcome was blood pressure-lowering prescription fills during 2017-2023, utilizing a list of 113 generic medications from 21 drug classes. In addition, a subset of 20 medications recommended in the 2017 American Academy of Pediatrics guideline was examined. Annual population percentage and percentage change compared with 2017 were reported, and average annual percentage change was estimated using Joinpoint regression.

Results: From 2017 to 2023, blood pressure-lowering prescription fills among those aged 3-17 years increased slightly from 1.93% (95% CI=1.88%, 1.98%) to 2.09% (95% CI=2.04%, 2.14%). Among males, blood pressure-lowering prescription fills remained stable (between 2.32% and 2.38%; average annual percentage change= -0.3%; p=0.545), whereas fills among females increased by 23.9% (from 1.49% to 1.84%; average annual percentage change=4.16%; p<0.001). The sharpest increase occurred among females aged 13-17 years (from 2.26% to 3.17%; average annual percentage change=6.3%; p<0.001). Prescription fills for guideline-recommended medications either remained stable or declined, with some variation by sex and age group.

Conclusions: Results indicate growth in blood pressure-lowering prescription fills, especially among females aged 13-17 years. Increases were driven by medications not included in the 2017 American Academy of Pediatrics guideline, suggesting that blood pressure-lowering medications may be increasingly prescribed for conditions other than pediatric hypertension.

Keywords: Blood pressure–lowering medications; antihypertensives; blood pressure; clinical practice guideline; pediatric hypertension.

Figure 1

Percentage of U.S. population aged 3–17 years with prescription fills for generic BP-lowering medications by sex and age group, IQVIA Total Patient Tracker, 2017–2023. This figure shows the annual trend of individuals with prescription fills for generic BP-lowering medication among males and females aged 3–17 years during 2017–2023 using U.S. population estimates by sex and age group for all years. Owing to the unavailability of data for 2023, the population total of Year 2022 was also used for Year 2023. Population percentages with 95% CIs and changes from 2017 to 2023 are presented in Appendix Table 2. Trends with p-value are presented. BP, blood pressure.

Figure 2

Percentage of U.S. population aged 3–17 years with prescription fills for generic BP-lowering medications mentioned in the 2017 AAP guideline for outpatient management of chronic hypertension by sex and age group, IQVIA Total Patient Tracker, 2017–2023. This figure shows the annual prescription trend of generic BP-lowering medications mentioned in the 2017 AAP guideline among males and females aged 3–17 years during 2017–2023 using U.S. population estimates by sex and age group for all years. Owing to the unavailability of data for 2023, the population total of Year 2022 was also used for Year 2023. Population percentages with 95% CIs and changes from 2017 to 2023 are presented in Appendix Table 3. Trends with p-value are presented. AAP, American Academy of Pediatrics; BP, blood pressure.