Trends in antihypertensive drug use in the United States: Do the JNC V recommendations affect prescribing?

David Siegel, Julio Lopez

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Abstract

Context. - The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications. Objectives. - To describe national antihypertensive medication PreScribing patterns for 1992 and 1995; to explore the influence of the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V), published in 1993, which recommended diuretics and β-blockers as first-line antihypertensive therapy unless contraindicated; and to estimate the impact of these prescribing patterns on the cost of antihypertensive treatment. Design. - All prescriptions for drugs approved for the treatment of hypertension dispensed by 35 000 retail pharmacies were tabulated for 1992 and 1995 (62% of all US retail pharmacies were Surveyed). Main Outcome Measures. - Number of prescriptions for each dosage form of medication and national Cost estimates based on wholesale costs of medications dispensed. Results. - In 1992, of the 10 most frequently, prescribed antihypertensive drugs, 3 were calcium antagonists, 3 were angiotensin-converting enzyme (ACE) inhibitors, 3 were β-blockers, and 1 was the combination of triamterene and hydrochlorothiazide. In 1995, 4 were calcium antagonists, 3 were ACE inhibitors 1, was a β-blocker 1 was the combination of triamterene and hydrochlorothiazide, and 1 an α-blocker. In 1992 calcium antagonists accounted for 33% of antihypertensive prescriptions compared with 38% in 1995. ACE inhibitor use went from 25% to 33%, β-blocker use from 18% to 11%, and diuretic use from 16% to 8%. The estimated wholesale costs for calcium antagonists in 1995-dollars increased from $2.67 billion in 1992 to $2.86 billion in 1995; ACE inhibitor costs increased from $1.37 billion to $1.67 billion; costs for diuretics declined from $353 million to $168 million; and costs for β-blockers declined from $763 million to $433 million. Conclusions. - From 1992 to 1995 use of calcium antagonists and ACE inhibitors for treatment of hypertension increased and diuretics and β- blockers declined, suggesting that the recommendations from JNC V had little effect on prescribing patterns. The cost implications of these practice patterns are enormous.

Original languageEnglish (US)
Pages (from-to)1745-1748
Number of pages4
JournalJournal of the American Medical Association
Volume278
Issue number21
StatePublished - Dec 3 1997

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ASJC Scopus subject areas

  • Medicine(all)

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