Real world hypertension treatment patterns analysis identifies putative gaps and risk-associated patterns

ObjectiveAlthough treatment patterns analyses at scale can provide insights into associated health outcomes, they remain relatively uncharacterized for most chronic diseases, including hypertension (HTN). To address this gap, we analyzed HTN treatment patterns among US health-insured patients. Materials and MethodsNew (n = 200,786) or all (n = 4.1 million) HTN patients were identified from 2015, 2016 enrollments in a nationwide administrative claims database and compared for HTN-specific treatment (Rx) choices, Rx count, and distinct rounds of treatment options (ROTO), respectively. Selected treatment patterns were risk-assessed using predictive modeling and/or literature-based recommendations. ResultsFor 2016, ACE inhibitors/ARBs were most frequent choices in new HTN patients vs more diverse Rx-choices among all HTN patients. All HTN patients had [~]3-fold and [~]5-fold-higher prevalence of (same-year) polytherapy and Rx interventions, respectively. New HTN patients with [&ge;]2 rounds of treatment options (vs single/initial round) were associated with [~]5-fold or higher predicted HTN complications risk (p-value < 0.0001). All HTN patients with [&ge;]3 rounds of treatment options (vs single/initial round) had 3.8-fold higher next-year HTN complications risk (p-value < 0.0001). Co-morbidities/persistence of [&ge;]3 rounds of treatment options over 2 years further increased these odds and total medications/chronic disease score correlated with ROTO counts. Discussion[~]95% of new HTN patients in 2016 did not start treatment with current literature-recommended first option, Thiazides. Assuming "sticky" prescription patterns, opportunity exists to improve (current) initial HTN treatments. Additionally, ROTO counts can inform HTN complications risk/management thereof. ConclusionWe highlight opportunities to improve initial HTN treatments and treatment patterns associated with higher risk among HTN patients.