Article Text
PDF
Abstract
Objective To examine the UK practice patterns in treating newly diagnosed hypertension and to determine whether subgroups of high-risk patients are more or less likely to follow particular therapeutic protocols and to reach blood pressure goals.
Design Retrospective cohort study.
Setting This study examined adults in The Health Improvement Network (THIN) UK general practice medical records database who were initiated on medication for hypertension.
Participants 48 131 patients with essential hypertension diagnosed between 2008 and 2010 who were registered with a participating practice for a minimum of 13 months prior to, and 6 months following, initiation of therapy. We excluded patients with gestational hypertension or secondary hypertension. Patients were classified into risk groups based on blood pressure readings and comorbid conditions.
Primary and secondary outcome measures Odds of receiving single versus fixed or free-drug combination therapy and odds of achieving blood pressure control were assessed using multivariable logistic regression.
Results The vast majority of patients (95.8%) were initiated on single drug therapy. Patients with high cardiovascular risk (patients with grade 2–3 hypertension or those with high normal/grade 1 hypertension plus at least one cardiovascular condition pretreatment) had a statistically significant benefit of starting immediately on combination therapy when blood pressure control was the desired goal (OR: 1.23; 95% CI: 1.06 to 1.42) but, surprisingly, were less likely than patients with no risk factors to receive combination therapy (OR: 0.53; 95% CI: 0.47 to 0.59).
Conclusions Our results suggest that combination therapy may be indicated for patients with high cardiovascular risk, who accounted for 60.6% of our study population. The National Institute for Health and Care Excellence guideline CG34 of 2006 (in effect during the study period) recommended starting with single drug class therapy for most patients, and this advice does seem to have been followed even in cases where a more aggressive approach might have been considered.
- hypertension
- combination therapy
- diabetes mellitus
- kidney disease
- cardiovascular disease
- The health Improvement network (THIN) database
- NICE clinical guidelines.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Footnotes
Contributors SW, AJ, JP and TT contributed to the conception or design of the work. SW was involved in data acquisition and carried out data analysis and interpretation. SW, AJ, JP and TT participated in the drafting of the article. SW and TT were responsible for the critical revision of the article. SW, AJ, JP and TT gave final approval of the version to be published.
Competing interests AJ and JP were employed by Takeda Europe, who provided funding for this study to PHMR. SW received consulting fees from PHMR to conduct the analyses and prepare the manuscript but has no ongoing conflict of interest in relation to the research results. TST has no personal, financial or institutional conflicts of interest associated with this work, nor has he ever received any fees or monetary compensation of any kind for his authorship contribution.
Ethics approval Scientific Review Committee, Cegedim Strategic Data Medical Research UK (now IMS Health).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional unpublished data from the study are available.