Department of Epidemiology, University of Alabama at Birmingham, Birmingham.
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City.
JAMA Netw Open. 2020 Nov 2;3(11):e2025127. doi: 10.1001/jamanetworkopen.2020.25127.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
2013 年 12 月，第八届联合国家预防、检测、评估和治疗高血压委员会（JNC8）的小组成员发表了一项建议，即非黑人成年人应使用噻嗪类利尿剂、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）启动抗高血压药物治疗，而黑人成年人则应使用噻嗪类利尿剂或钙通道阻滞剂启动治疗。β-受体阻滞剂不推荐作为一线治疗药物。
评估 JNC8 小组成员报告发布前后种族/族裔启动的抗高血压药物类别变化。
设计、地点和参与者：这项连续的横断面分析评估了 2011 年至 2018 年间开始使用抗高血压药物的年龄在 66 岁或以上的 5%的 Medicare 受益人群，他们是黑人（n=3303[8.0%]）、白人（n=34943[84.5%]）或其他（n=3094[7.5%]）种族/族裔，并且没有特定抗高血压药物类别的强制性适应症。
日历年度和 JNC8 小组成员报告发布后的时期。
启动 ACEI 或 ARB 以及单独的β-受体阻滞剂与其他抗高血压药物类别相比的受益人数比例。
共有 41340 名 Medicare 受益人群（65%为女性；平均[SD]年龄为 75.7[7.6]岁），他们为黑人、白人和其他种族/族裔，并且符合本研究的纳入标准。2011 年，25.2%开始使用单一抗高血压药物治疗的黑人受益人群使用 ACEI 或 ARB 治疗，而 2018 年为 23.7%（趋势 P=.47）。在开始使用单一疗法的受益人群中，2011 年开始使用β-受体阻滞剂的白人受益人群比例为 20.1%，而 2018 年为 15.4%（趋势 P< .001），2011 年开始使用β-受体阻滞剂的黑人受益人群比例为 14.2%，而 2018 年为 11.1%（趋势 P=.08），2011 年开始使用β-受体阻滞剂的其他种族/族裔受益人群比例为 11.3%，而 2018 年为 15.0%（趋势 P=.40）。在多变量调整后，在黑人与白人受益人群中，在 JNC8 小组成员报告发布前后，开始使用单一疗法的受益人群中使用 ACEI 或 ARB 的比例没有变化（患病率比，1.00；95%CI，0.97-1.03）或黑人与白人受益人群之间的差异（患病率比，0.96；95%CI，0.83-1.12；交互作用 P=.60）。在开始使用单一疗法的受益人群中，β-受体阻滞剂的使用比例从 JNC8 小组成员报告发布前到发布后下降（患病率比，0.89；95%CI，0.84-0.93），不同种族/族裔群体之间没有差异（交互作用 P> .10）。
相当一部分开始使用抗高血压药物的美国成年老年人使用的是非指南推荐类别的药物。
