Elevated blood pressure, or hypertension, is the leading cause of cardiovascular disease and related mortality worldwide. However, most patients with hypertension can effectively manage their blood pressure and reduce their risk of complications through lifestyle changes and/or a variety of available blood pressure lowering medications. In most cases, patients will require more than one such medication to keep their blood pressure in control. In the United Kingdom (UK) however, physicians are recommended to begin patients on monotherapy – a single blood pressure lowering medication – and adding on additional medications only once the initial treatment proves inadequate. In contrast, other countries recommend that physicians begin patients on combination therapy – two or more blood pressure lowering medications simultaneously. In this project we will describe trends over time in the rate of new prescriptions for combination therapy and monotherapy and characteristics of patients in the UK primary care settings, Finally, we will describe changes to the management of hypertension in primary care associated with COVID-19 pandemic-related restrictions.
Elevated blood pressure, or hypertension, is the leading cause of cardiovascular disease and related mortality worldwide. To manage hypertension, guidelines published by the UK’s National Institute for Health and Care Excellence (NICE) recommend a stepped treatment plan in which patients begin on a single antihypertensive medication and treatment is intensified (either by increasing the dose of a patient’s current medication or adding on an additional medication) if control is not achieved or cannot be maintained on a patient’s current medication. In contrast, European, American, and International guidelines recommend initiating treatment with two antihypertensive medications if blood pressure is at least 20/10 mmHg above target. No study has specifically assessed patterns of prescribing combination therapy as first-line treatment in the UK. We will therefore conduct a cohort study aiming to describe trends in the prescribing of combination vs. monotherapy as initial treatment for hypertension over time in patients over 18 years of age in the CPRD between 2011 and 2022. We will calculate yearly incidence rates of prescriptions for combination and monotherapy as first-line treatment for hypertension, and use Kaplan-Meier curves to quantify the expected length of time a patient will remain on their first-line treatment, stratified by combination vs. monotherapy. Further, because the COVID-19 pandemic has had such a profound impact on healthcare delivery, we will describe the impact of pandemic-related restrictions on hypertension management in primary care. We will use negative binomial regression to predict expected monthly rates of hypertension diagnosis, prescriptions for antihypertensive medications, and essential health checks defining high quality care for hypertension (as recommended by NICE in the Quality and Outcomes Framework) and compare them to observed rates during the pandemic.
Hypertension diagnosis (Appendix 1); Prescription of antihypertensive medication (Appendix 2); Blood pressure measurements.
Baseline characteristics of patients newly prescribed antihypertensive medication
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Christel Renoux - Corresponding Applicant - McGill University
James Brophy - Collaborator - McGill University
Kyle Johnson - Collaborator - McGill University
Robert Platt - Collaborator - McGill University
Sarah Beradid - Collaborator - Sir Mortimer B Davis Jewish General Hospital