Almost 61% of adults in the United States (US) with hypertension who are taking 2 or more antihypertensive medications are using a regimen that cannot be converted to a single-class-equivalent fixed-dose combination (FDC) medication, according to a study in the Journal of the American Heart Association.

Researchers used data from the National Health and Nutrition Examination Survey (NHANES) to determine the antihypertensive medication regimens used by US adults taking 2 or more antihypertensive medications and estimate the degree to which available FDC products meet the needs of real-world treatment patterns.

The analysis included NHANES participants aged 20 years or older with complete blood pressure and medication data available from 2015 to 2016 and 2017 to March 2020. Each participant’s antihypertensive medication regimen was categorized based on the medication classes used.

The primary outcome was the availability of the full antihypertensive medication regimen as 1 FDC product and was assessed at the class combination level.

The cohort included 2451 participants (weighted N=34.1 million) with hypertension who were taking 2 or more antihypertensive medications. Their mean age was 66.0 years, 52.8% were women, and 69.1% self-reported as non-Hispanic White race and ethnicity. A majority of the participants (60.6%) were taking 2 antihypertensive medications. The proportions of who were receiving medications from 3, 4, and 5 or more antihypertensive classes were 28.2%, 9.1%, and 1.6%, respectively.

Overall, 189 unique class regimens were defined by combinations of antihypertensive medication classes used. The most frequent 2-class regimen was an angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker and a thiazide (20.1%; 95% CI, 17.5%-22.7%), which was used by an estimated 6.9 million US adults (95% CI, 5.8-8.0 million).

Among the regimens used by US adults with hypertension who were taking 2 or more medications, 7 are available as a class-equivalent FDC product. Among the 31 two-class combinations and 58 three-class combinations that were used, 6 and 1, respectively, are available as a 1-class-equivalent FDC product. No FDC products containing 4 or more antihypertensive classes are available.

Overall, 39.2% (95% CI, 35.5%-43.0%; 13.4 million; 95% CI, 11.8-15.0 million) of US adults are using a regimen that is available as a 1-class-equivalent FDC product, and 60.8% of US adults (95% CI, 57.0%-64.5%; 20.7 million; 95% CI, 18.6-22.9 million) are not.

For individuals who are using only 2 antihypertensive classes, 62.8% (95% CI, 58.7%-66.8%; 13.0 million; 95% CI, 11.4-14.5 million) are able to receive their full regimen in a 1-class-equivalent FDC product, and 4.2% (95% CI, 1.6%-6.9%; 0.4 million; 95% CI, 0.1-0.7 million) of US adults who are using 3 antihypertensive medication classes can receive their complete regimen in an available class-equivalent FDC product.

Limitations of the study include the unavailability of medication doses in NHANES, and the researchers were unable to differentiate between use of FDCs with metoprolol tartrate vs succinate. Also, the cross-sectional study could not determine the regimen appropriateness for each participant.

“There is a substantial gap between the FDC products available on the market and the real-world treatment patterns among US adults with hypertension,” stated the investigators. “Significant improvements in clinician use of regimens currently available as an FDC and in the FDC product armamentarium are needed to realize the benefits of FDC products in clinical care.”

References:

Derington CG, Bress AP, Herrick JS, et al. Antihypertensive medication regimens used by US adults with hypertension and the potential for fixed-dose combination products: the National Health and Nutrition Examination Surveys 2015 to 2020. J Am Heart Assoc. Published online May 9, 2023. doi: 10.1161/JAHA.122.028573