Patterns of Antihypertensive Drug Utilization among US Adults with Diabetes and Comorbid Hypertension: The National Health and Nutrition Examination Survey 1999-2014.

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Clinical Medicine Insights. Cardiology Pub Date : 2019-04-12 eCollection Date: 2019-01-01 DOI:10.1177/1179546819839418

Anna Gu, Shireen N Farzadeh, You Jin Chang, Andrew Kwong, Sum Lam

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Abstract

Background: Diabetes and hypertension are the 2 leading risk factors for suboptimal cardiovascular and renal outcomes. These 2 conditions often coexist and can benefit from antihypertensive therapy, which may lead to blood pressure control and reduced risk for nephropathy (as evidenced by albuminuria).

Objective: To quantify the trends of antihypertensive drug use and to assess the impact of antihypertensive treatment on the prevalence of blood pressure control and albuminuria, among US adults with coexisting diabetes and hypertension.

Methods: In this serial cross-sectional study, we analyzed data from the 1999-2014 National Health and Nutrition Examination Survey (N = 3586). We determine the prevalence of antihypertensive use, drug classes used, and their association with blood pressure control and albuminuria.

Results: During the study period, the study population experienced substantial increase in antihypertensive treatment (from 84.6% in 1999-2002 to 90.1% in 2011-2014, P_trend < .01) and blood pressure control (from 37.1% to 46.9%, P_trend < .01) and decrease in albuminuria (from 39.1% to 31.3%, P_trend = .02). These trends were particularly pronounced in the subgroups using angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers. In multivariate analysis, Blacks, Hispanics, and males were found more likely to have albuminuria than their respective counterparts. Achieving blood pressure control (odds ratio = 0.40, 95% confidence interval [CI]: 0.32-0.49) was associated with lower rates of albuminuria.

Conclusion and relevance: Despite continued improvement in antihypertensive therapy, the burden of uncontrolled blood pressure and albuminuria remains substantial among US adults with diabetes and hypertension. Tailoring pharmacotherapy based on patient characteristics and comorbidities is needed to further improve these outcomes.

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美国糖尿病和合并高血压成年人的抗高血压药物使用模式：1999-2014年全国健康和营养检查调查。

背景：糖尿病和高血压是导致心血管和肾脏预后不理想的两个主要危险因素。这两种情况经常共存，可以从降压治疗中受益，这可能会控制血压并降低肾病的风险（如蛋白尿所证明的）。目的：量化降压药物的使用趋势，并评估降压治疗对血压控制和蛋白尿患病率的影响，在患有糖尿病和高血压的美国成年人中。方法：在本系列横断面研究中，我们分析了1999-2014年全国健康和营养检查调查（N = 3586）。我们确定了抗高血压药物的使用率、使用的药物类别及其与血压控制和蛋白尿的关系。结果：在研究期间，研究人群的降压治疗显著增加（从1999-2002年的84.6%增加到2011-2014年的90.1%，Ptrend Ptrend Ptrend = .02）。这些趋势在使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂的亚组中尤为明显。在多变量分析中，发现黑人、西班牙裔和男性比各自的同龄人更容易出现蛋白尿。实现血压控制（比值比 = 0.40，95%置信区间[CI]:0.32-0.49）与较低的蛋白尿发生率相关。结论和相关性：尽管降压治疗持续改善，但在患有糖尿病和高血压的美国成年人中，不受控制的血压和蛋白尿的负担仍然很大。需要根据患者特征和合并症量身定制药物治疗，以进一步改善这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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