Diem Tran, MPH, MS and Amy B. Bernstein, ScD. Office of Analysis, Epidemiology and Health Promotion, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, 000-000-0000, sigma_six6@yahoo.com

Introduction: Affecting millions of Americans, the physical and economic impact of hypertension is considerable. Research into antihypertensive drug therapy utilization in populations at highest risk and severity of hypertension remains scarce. This paper investigates prevalence patterns in use of antihypertensive drug therapies—including monotherapy (use of one antihypertensive medication) and combination therapy (use of more than one antihypertensive medication in the past month)—and examines how these trends vary by age, gender, race/ethnicity and education. Methods: Data are from the interview component of the 1988-1994 and 1999-2000 National Health and Nutrition Examination Survey (NHANES). Antihypertensive drug therapy trends were analyzed for persons 20 years and over who report being told by a physician or other health professional on two or more different visits that they had hypertension or high blood pressure. NHANES is a stratified, multistage survey of the noninstitutionalized, civilian population of the United States. Results: Relative to their comparison groups, the prevalence of diagnosed hypertension in 1988-1994 and 1999-2000 was higher for persons over 59 years of age, women, persons without a high school diploma and non-Hispanic blacks. In 1999-2000, more people with diagnosed hypertension used antihypertensive drug therapy than in 1988-1994. Older age groups, females and those with less than a high school diploma were more likely to use drug therapy compared to younger adults, men, and more educated persons. Persons of Mexican origin were the least likely of the race/ethnicity categories to use drug therapy. Between the two surveys, utilization of monotherapy remained steady with no clear differences in the trend by age group, gender, race/ethnicity or educational attainment. Combination therapy, however, increased. In both surveys, the use of combination therapy was positively associated with age and negatively correlated with educational attainment. Females were more likely to use combination therapy than males, and Mexicans were the least likely of the race/ethnicity groups to use combination therapy. Conclusions: Greater utilization of combination therapy suggests a shift toward more tailored antihypertensive drug regiments. This trend is consistent with the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guidelines. Differentials in use of combination therapy by gender and race/ethnicity warrant further investigation.

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