Association of Race/Ethnicity-Specific Changes in Antihypertensive Medication Classes Initiated Among Medicare Beneficiaries With the Eighth Joint National Committee Panel Member Report.
Association of Race/Ethnicity-Specific Changes in Antihypertensive Medication Classes Initiated Among Medicare Beneficiaries With the Eighth Joint National Committee Panel Member Report.
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DOI：
10.1001/jamanetworkopen.2020.25127
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Bress A
中科院分区：
文献类型：
--
作者：
Colvin CL;King JB;Oparil S;Wright JT Jr;Ogedegbe G;Mohanty A;Hardy ST;Huang L;Hess R;Muntner P;Bress A
在第八届高血压预防、检测、评估和治疗全国联合委员会小组成员报告发表后，美国老年高血压患者的初始抗高血压药物方案是否发生了变化？在这项对4340名医疗保险受益人的连续横断面研究中，在小组成员报告发表后，黑人受益人开始使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂进行抗高血压单药治疗的比例没有统计学上的显著变化。在所有种族/民族中，启动β受体阻滞剂单药治疗的比例仍然很高。许多开始服用抗高血压药物的美国老年人使用非指南推荐的药物类别。2013年12月，第八届高血压预防、检测、评估和治疗全国联合委员会（JNC8）任命的专家组成员发表了一项建议，建议非黑人成年人开始使用噻嗪类利尿剂、钙通道阻滞剂、血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）进行降压治疗，而黑人成年人开始使用噻嗪类利尿剂或钙通道阻滞剂。β受体阻滞剂不推荐作为一线治疗。评估JNC8小组成员报告发表前后，按种族/民族开始的抗高血压药物类别的变化。该系列横断面分析评估了2011年至2018年期间开始抗高血压药物治疗的66岁及以上医疗保险受益人的5%样本，包括黑人（n = 3303[8.0%]）、白人（n = 34943[84.5%]）或其他（n = 3094[7.5%]）种族/民族，并且没有特定抗高血压药物类别的令人信服的适应症。JNC8小组成员报告发表前后的历年和期间。受益人分别使用acei或arb和β受体阻滞剂与其他抗高血压药物类别的比例。总共有41 340名黑人、白人或其他种族的医疗保险受益人（65%为女性，平均[SD]年龄75.7[7.6]岁）开始抗高血压药物治疗，符合本研究的纳入标准。2011年，25.2%的黑人受益人在开始抗高血压单药治疗时使用了ACEI或ARB，而2018年这一比例为23.7%。47代表趋势)。在开始单药治疗的受益人中，白人受益人填充β受体阻滞剂的比例在2011年为20.1%，在2018年为15.4% （P < 0.05）。趋势为001)，2011年为14.2%，2018年为11.1%。趋势为08)，其他种族/族裔受益人2011年为11.3%，2018年为15.0% (P =。40代表趋势)。在多变量调整和开始单药治疗的受益人中，没有证据表明在JNC8小组成员报告发表前后填写ACEI或ARB的比例发生变化（患病率比，1.00;95% CI, 0.97-1.03）或黑人与白人受益人(患病率比，0.96;95% CI, 0.83-1.12; P =。交互为60)。在开始单药治疗的受益人中，服用β受体阻滞剂的比例从JNC8小组成员报告发表前到发表后下降（患病率，0.89;95% CI, 0.84-0.93），不同种族/民族之间没有差异（P < 0.05）。10为互动)。相当大比例的美国老年人开始服用非指南推荐的抗高血压药物。本系列横断面研究评估了从第八届全国预防、检测、评估和治疗高血压联合委员会小组成员报告发表之前到之后，在5%的66岁或以上的医疗保险受益人样本中，是否发生了任何种族/民族特异性的抗高血压药物类别的变化。
Have the initial antihypertensive medication regimens filled by older US adults with hypertension changed following publication of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure panel member report? In this serial cross-sectional study of 41 340 Medicare beneficiaries, there was no statistically significant change in the proportion of Black beneficiaries initiating antihypertensive monotherapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker following publication of the panel members’ report. The proportion initiating β-blocker monotherapy remained high among all race/ethnicity groups. Many older US adults who initiate antihypertensive medication do so with non–guideline-recommended classes of medication. In December 2013, the panel members appointed to the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8) published a recommendation that non-Black adults initiate antihypertensive medication with a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB), whereas Black adults initiate treatment with a thiazide-type diuretic or calcium channel blocker. β-Blockers were not recommended as first-line therapy. To assess changes in antihypertensive medication classes initiated by race/ethnicity from before to after publication of the JNC8 panel member report. This serial cross-sectional analysis assessed a 5% sample of Medicare beneficiaries aged 66 years or older who initiated antihypertensive medication between 2011 and 2018, were Black (n = 3303 [8.0%]), White (n = 34 943 [84.5%]), or of other (n = 3094 [7.5%]) race/ethnicity, and did not have compelling indications for specific antihypertensive medication classes. Calendar year and period after vs before publication of the JNC8 panel member report. The proportion of beneficiaries initiating ACEIs or ARBs and, separately, β-blockers vs other antihypertensive medication classes. In total, 41 340 Medicare beneficiaries (65% women; mean [SD] age, 75.7 [7.6] years) of Black, White, or other races/ethnicities initiated antihypertensive medication and met the inclusion criteria for the present study. In 2011, 25.2% of Black beneficiaries initiating antihypertensive monotherapy did so with an ACEI or ARB compared with 23.7% in 2018 (P = .47 for trend). Among beneficiaries initiating monotherapy, the proportion filling a β-blocker was 20.1% in 2011 and 15.4% in 2018 for White beneficiaries (P < .001 for trend), 14.2% in 2011 and 11.1% in 2018 for Black beneficiaries (P = .08 for trend), and 11.3% in 2011 and 15.0% in 2018 for beneficiaries of other race/ethnicity (P = .40 for trend). After multivariable adjustment and among beneficiaries initiating monotherapy, there was no evidence of a change in the proportion filling an ACEI or ARB before to after publication of the JNC8 panel member report overall (prevalence ratio, 1.00; 95% CI, 0.97-1.03) or in Black vs White beneficiaries (prevalence ratio, 0.96; 95% CI, 0.83-1.12; P = .60 for interaction). Among beneficiaries initiating monotherapy, the proportion filling a β-blocker decreased from before to after publication of the JNC8 panel member report (prevalence ratio, 0.89; 95% CI, 0.84-0.93) with no differences across race/ethnicity groups (P > .10 for interaction). A substantial proportion of older US adults who initiate antihypertensive medication do so with non–guideline-recommended classes of medication. This serial cross-sectional study assesses whether any race/ethnicity-specific changes occurred from before to after publication of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure panel member report for the initiation of antihypertensive medication classes in a 5% sample of Medicare beneficiaries aged 66 years or older.
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影响因子：
37.8
作者：
Gu, Qiuping;Burt, Vicki L.;Yoon, Sarah
通讯作者：
Yoon, Sarah
影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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