The prescribing to patients with hypertension with or without comorbidities of optimized drug combinations with complementary modes of action for the lowering of blood pressure (BP) was not found to be widely adopted, according to a study published in the American Journal of Hypertension.

Deidentified electronic health record (EHR) data of ambulatory patients with hypertension (n=27,579) were obtained from the University of Florida Health Integrated Data Repository. The presence of hypertension was identified based on prescription data and self-reports. The investigators examined the data of patients taking 2 and ≥2 antihypertensive drug classes.

An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker plus a calcium channel blocker or diuretic were  considered a preferred drug class combination.

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A total of 65% of patients who were treated had controlled BP (ie, BP <140/90 mm Hg). A preferred dual antihypertensive therapy was prescribed to 55% of patients with uncomplicated hypertension, 49% of patients with diabetes, and 47% of patients with myocardial infarction. There was a trend toward an association between an improvement in BP control and the prescription of a preferred drug class combination for patients with uncomplicated hypertension (odds ratio [OR], 1.11; 95% CI, 0.98-1.26; P =.089) and for patients with a history of myocardial infarction (OR, 1.21; 95% CI, 0.99-1.48; P =.061).

Study limitations include the analysis of prescriptions data from a single university center and the lack of data on treatment adherence and dosages.

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“[O]ur analysis does not clearly support the recommendations of preferred combinations for optimal BP control,” noted the study authors. “Overall, our study demonstrates an HER-based approach to investigating healthcare issues among patients in a real-world clinical setting where there may be implications to implement clinical decision support to improve healthcare at the community and health system-wide level.”


Magvanjav O, Cooper-DeHoff RM, McDonough CW, et al. Combination antihypertensive therapy prescribing and blood pressure control in a real-world setting [published online December 19, 2019]. Am J Hypertens. doi: 10.1093/ajh/hpz196