Blood Pressure Control and Pharmacotherapy Patterns in the United States Before and After the Release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Guidelines

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Figure 1.
Classification of diastolic and systolic blood pressure according to JNC Guidelines 1 to 7.
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Figure 2.
Recommended angiotensin converting enzyme inhibitor, angiotensin II receptor blocker, and beta-blocker use in patients with compelling indications.
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Figure 3.
Blood pressure control as defined by prevailing criteria.
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Figure 4.
Blood pressure control by patient characteristics.
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Figure 5.
Blood pressure control over time (prevailing JNC guidelines). N = total sample size during time point of interval.

Table 1.

Demographic Characteristics

Table 2.

Comorbid Conditions and Cardiovascular Risk Factors

Presence of Comorbid Conditions and Cardiovascular Risk Factors	Before-JNC 7 Cohort n = 15,258 (n [%])	After-JNC 7 Cohort n = 4000 (n [%])	P
Age (years)^*	7726 (50.8)^†	2246 (56.2)	<.0001
Angina	1739 (11.4)	796 (19.9)	<.0001
CABG	1582 (10.4)	296 (7.4)	<.0001
Cigarette smoking	3006 (19.7)	551 (13.8)	<.0001
Diabetes	3369 (22.1)	1481 (37.0)	<.0001
Family history of CVD	3545 (25.1)^‡	1805 (45.1)	<.0001
Heart failure	692 (4.5)	310 (7.8)	<.0001
Hyperlipidemia	7882 (53.0)^§	2646 (66.2)	<.0001
Left ventricular hypertrophy	524 (3.7)^‖	377 (9.4)	<.0001
Nephropathy	390 (2.8)^¶	207 (10.3)^#	<.0001
Obese	2542 (50.0)^**	1433 (48.1)^††	.1092
PAD	614 (4.0)	234 (5.9)	<.0001
Previous MI	876 (5.7)	387 (9.7)	<.0001
Retinopathy	270 (2.0)^‡‡	149 (3.7)	<.0001
Stroke	880 (5.8)	266 (6.7)	.0392

Because of the retrospective, naturalistic design of this study, some data elements were either not available or unable to be determined from the chart reviews. In those cases, the missing values were not included in the denominator of the above percentages. The frequency of this missing information (thus, the number subtracted from the denominator) is as follows:
† 51
‡ 1116
§ 389
‖ 1116
¶ 1505
# 1988
** 10174
†† 1021
‡‡ 1505.
* >55 for men and >65 for women.
CABG, coronary artery bypass graft; CVD, cardiovascular disease; PAD, peripheral artery disease; MI, myocardial infarction.

Table 3.

Prescribing Patterns

	Before-JNC 7 Cohort (n = 15,258)	After-JNC 7 Cohort n = 4,000	P
Number of agents (n [%])
No drug therapy	908 (6.7)	249 (6.2)	<.0001
Monotherapy	6196 (45.4)	1365 (34.1)
Dual therapy	4283 (31.4)	1425 (35.6)
Triple+ therapy	2251 (16.5)	961 (24.0)
Class of agents used in patients receiving therapy (n [%])	n = 14,350^†	n = 3751
Beta-blockers	3739 (29.4)	1340 (35.7)	<.0001
ACE inhibitors	4248 (33.4)	1229 (32.7)
Calcium channel blockers	3644 (28.6)	967 (25.8)
ARBs	1033 (8.1)	508 (13.5)	<.0001
Diuretics–total	3950 (31.0)	1522 (40.6)	<.0001
Thiazide	889 (7.0)	748 (19.9)	<.0001
Nonthiazide	3061 (24.0)	774 (20.6)
Alpha-blockers	708 (5.6)	259 (6.9)	.0020
Fixed-dose combination agents^*	1516 (11.9)	783 (20.8)	<.0001

* Fixed-dose combination agents included ACE inhibitor/calcium channel blocker, ACE inhibitor/diuretic, ARB/diuretic, beta-blocker/diuretic, or vasodilator/diuretic.
† Includes patients’ prescribed antihypertensive therapy.
ACE, angiotensin converting enzyme; ARB, angiotensin II receptor blocker.