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Research ArticleResearch Letter

Anti-Hypertensive Medication Combinations in the United States

Michael E. Johansen, Jonathan Yun, James M. Griggs, Elizabeth Anne Jackson and Caroline R. Richardson
The Journal of the American Board of Family Medicine January 2020, 33 (1) 143-146; DOI: https://doi.org/10.3122/jabfm.2020.01.190134
Michael E. Johansen
the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR).
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Jonathan Yun
the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR).
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James M. Griggs
the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR).
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Elizabeth Anne Jackson
the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR).
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Caroline R. Richardson
the Grant Family Medicine, OhioHealth, Columbus, OH (MEJ, JMG); Heritage College of Osteopathic Medicine at Ohio University, Dublin, OH (MEJ); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (JY); Department of Internal Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (EAJ); Department of Family Medicine, University of Michigan, Ann Arbor, MI (CRR).
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Article Figures & Data

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    Table 1.

    Proportion of Adult 2013 to 2017 Medical Expenditure Panel Survey Respondents Taking Each Medication Regimen by Comorbidity Group

    HTN OnlyHTN-DMHTN-CVDHTN-DM-CVD
    Number of individuals8016348025331872
    Proportion of sample52.8 (51.5, 54.2)19.0 (18.0, 20.1)17.2 (16.1, 18.3)10.9 (10.2, 11.7)
    Number of HTN medications
        148.9 (47.0, 50.8)37.8 (34.9, 40.7)33.9 (31.3, 36.6)23.7 (20.8, 26.8)
        235.7 (33.9, 37.5)33.9 (31.3, 36.5)37.2 (34.4, 40.1)37.2 (33.8, 40.7)
        312.7 (11.7, 13.8)20.8 (18.5, 23.3)20.1 (17.7, 22.6)26.2 (23.1, 29.5)
        42.3 (1.9, 2.8)6.2 (5.0, 7.7)7.3 (5.9, 9.1)10.3 (8.5, 12.6)
        ≥50.4 (0.2, 0.6)1.4 (0.9, 2.1)1.5 (1.0, 2.4)2.6 (1.9, 3.7)
    1 Medication
        ACE/ARB25.2 (23.8, 26.8)28.3 (25.6, 31.1)12.6 (10.8, 14.6)13.2 (10.8, 16.0)
        Thiazide6.2 (5.4, 7.1)2.4 (1.8, 3.4)2.4 (1.6, 3.6)0.9 (0.4, 2.0)
        Beta-blocker9.2 (8.2, 10.3)3.0 (2.3, 4.0)13.1 (11.2, 15.2)5.2 (4.1, 6.5)
        CCB7.0 (6.3, 7.8)3.2 (2.4, 4.3)4.7 (3.7, 5.9)2.6 (1.7, 4.1)
        Clonidine/hydralazine/loop/spironolactone1.3 (1.0 to 1.7)0.9 (0.5, 1.5)1.1 (0.7, 1.7)1.8 (1.2, 2.9)
    2 Medications
        ACE/ARB & CCB6.0 (5.2, 6.9)6.6 (5.4, 8.0)4.8 (3.6, 6.3)3.9 (2.8, 5.3)
        ACE/ARB & Beta-Blocker4.5 (3.9, 5.2)6.6 (5.3, 8.2)12.4 (10.6, 14.5)15.9 (13.5, 18.8)
        ACE/ARB & Thiazide15.5 (14.0, 17.1)12.9 (11.1, 14.9)5.7 (4.3, 7.4)6.3 (4.5, 8.5)
        ACE/ARB & Clonidine/Hydralazine/Loop/Spironolactone0.8 (0.6, 1.2)2.3 (1.5, 3.5)1.7 (1.1, 2.7)2.7 (1.8, 3.9)
        CCB & Thiazide1.6 (1.2, 2.0)0.7 (0.4, 1.2)1.0 (0.5, 1.7)0.3 (0.1, 0.7)
        CCB & beta-blocker1.8 (1.4, 2.3)1.0 (0.7, 1.5)4.0 (3.0, 5.3)2.1 (1.3, 3.1)
        CCB & Clonidine/hydralazine/loop/spironolactone0.4 (0.3, 0.7)0.4 (0.2, 0.7)0.7 (0.4, 1.3)1.3 (0.7, 2.5)
        Thiazide & Beta-blocker4.4 (3.6, 5.2)2.3 (1.7, 3.1)3.5 (2.6, 4.6)1.7 (1.0, 2.8)
        Thiazide & clonidine/hydralazine/loop/spironolactone0.2 (0.1, 0.4)0.1 (0.0, 0.3)0.3 (0.2, 0.7)0.1 (0.0, 0.5)
        Beta-blocker & clonidine/hydralazine/loop/spironolactone0.6 (0.4, 0.9)0.8 (0.5, 1.4)3.1 (2.2, 4.2)2.8 (1.9, 4.2)
        Clonidine/hydralazine/loop/spironolactone combination0.0 (0.0, 0.1)0.1 (0.0, 0.6)0.0 (0.0, 0.2)0.1 (0.0, 0.3)
    3 Medications
        ACE/ARB & CCB & beta-blocker1.8 (1.4, 2.3)2.8 (2.1, 3.9)3.9 (3.0, 5.2)5.5 (4.1, 7.4)
        ACE/ARB & CCB & thiazide4.2 (3.6, 5.0)6.7 (5.3, 8.5)2.0 (1.3, 3.0)3.1 (2.1, 4.4)
        ACE/ARB & beta-blocker & thiazide3.6 (3.0, 4.2)6.0 (4.6, 7.6)6.4 (5.1, 8.0)7.3 (5.7, 9.3)
        ACE/ARB & clonidine/hydralazine/diuretic/spiro & 1 other1.6 (1.3, 2.0)3.3 (2.6, 4.3)4.9 (3.9, 6.3)7.6 (5.9, 9.6)
        CCB & beta-blocker & thiazide0.8 (0.6, 1.2)0.9 (0.4, 2.0)1.0 (0.6, 1.8)0.6 (0.3, 1.1)
        Remaining 3 medication combinations without ACE/ARB0.6 (0.4, 0.9)0.9 (0.5, 1.7)1.7 (1.1, 2.7)2.2 (1.4, 3.4)
    4 or More Medications
        ACE/ARB included combinations2.5 (2.1, 3.1)7.1 (5.7, 8.8)8.1 (6.6, 9.9)11.9 (9.8, 14.34)
        4 or more medication classes without ACE/ARB0.2 (0.1, 0.3)0.5 (0.3, 0.9)0.8 (0.4, 1.4)1.1 (0.5, 2.2)
    • ACE, angiotensin converting-enzyme; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker; CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension.

    • There were 15,901 hypertensive adults without heart failure taking hypertension medication in the Medical Expenditure Panel Survey from 2013 through 2015. We divided our sample into four different comorbidity groups based on hypertension, diabetes, and cardiovascular disease (coronary heart disease or stroke) diagnoses. We then calculated the proportion of adults taking different single-drug and multi-drug hypertension medications regimens in each comorbidity group. Numbers in parentheses represent upper and lower limits of 95% CIs.

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The Journal of the American Board of Family     Medicine: 33 (1)
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Anti-Hypertensive Medication Combinations in the United States
Michael E. Johansen, Jonathan Yun, James M. Griggs, Elizabeth Anne Jackson, Caroline R. Richardson
The Journal of the American Board of Family Medicine Jan 2020, 33 (1) 143-146; DOI: 10.3122/jabfm.2020.01.190134

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Anti-Hypertensive Medication Combinations in the United States
Michael E. Johansen, Jonathan Yun, James M. Griggs, Elizabeth Anne Jackson, Caroline R. Richardson
The Journal of the American Board of Family Medicine Jan 2020, 33 (1) 143-146; DOI: 10.3122/jabfm.2020.01.190134
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