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Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

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A Capsule commentary to this article was published on 19 March 2014

ABSTRACT

BACKGROUND

Young adults with hypertension have the lowest prevalence of controlled blood pressure compared to middle-aged and older adults. Uncontrolled hypertension, even among young adults, increases future cardiovascular event risk. However, antihypertensive medication initiation is poorly understood among young adults and may be an important intervention point for this group.

OBJECTIVE

The purpose of this study was to compare rates and predictors of antihypertensive medication initiation between young adults and middle-aged and older adults with incident hypertension and regular primary care contact.

DESIGN

A retrospective analysis

PARTICIPANTS

Adults ≥ 18 years old (n = 10,022) with incident hypertension and no prior antihypertensive prescription, who received primary care at a large, Midwestern, academic practice from 2008–2011.

MAIN MEASURES

The primary outcome was time from date of meeting hypertension criteria to antihypertensive medication initiation, or blood pressure normalization without medication. Kaplan-Meier analysis was used to estimate the probability of antihypertensive medication initiation over time. Cox proportional-hazard models (HR; 95 % CI) were fit to identify predictors of delays in medication initiation, with a subsequent subpopulation analysis for young adults (18–39 years old).

KEY RESULTS

After a mean follow-up of 20 (±13) months, 34 % of 18–39 year-olds with hypertension met the endpoint, compared to 44 % of 40–59 year-olds and 56 % of ≥ 60 year-olds. Adjusting for patient and provider factors, 18–39 year-olds had a 44 % slower rate of medication initiation (HR 0.56; 0.47–0.67) than ≥ 60 year-olds. Among young adults, males, patients with mild hypertension, and White patients had a slower rate of medication initiation. Young adults with Medicaid and more clinic visits had faster rates.

CONCLUSIONS

Even with regular primary care contact and continued elevated blood pressure, young adults had slower rates of antihypertensive medication initiation than middle-aged and older adults. Interventions are needed to address multifactorial barriers contributing to poor hypertension control among young adults.

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Acknowledgements

Contributors

The authors gratefully acknowledge Katie Ronk, BS, for data preparation, and Jamie LaMantia, BS, and Colleen Brown, BA, for manuscript preparation.

Funders

Research reported in this manuscript was supported by the Clinical and Translational Science Award (CTSA) program, previously through the National Center for Research Resources (NCRR) under award number UL1RR025011, and now by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health under award number U54TR000021. Heather Johnson is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K23HL112907, and also by the University of Wisconsin Centennial Scholars Program of the University of Wisconsin School of Medicine and Public Health. Christie Bartels is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number K23AR062381. Nancy Pandhi is supported by the National Institute on Aging of the National Institutes of Health under award number K08AG029527. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additional funding for this project was provided by the University of Wisconsin Health Innovation Program and the University of Wisconsin School of Medicine and Public Health from The Wisconsin Partnership Program.

Prior Presentations

Some of the findings reported in the manuscript were presented in abstract form at the 2013 American Heart Association Quality of Care and Outcomes Research Scientific Sessions on 16 May 2013.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Heather M. Johnson MD, MS, Christie M. Bartels MD, MS & Ann M. Sheehy MD, MS

  2. Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Heather M. Johnson MD, MS, Christie M. Bartels MD, MS, Jessica R. Schumacher MS, PhD, Nancy Pandhi MD, MPH, PhD, Ann M. Sheehy MD, MS & Maureen A. Smith MD, PhD, MPH

  3. Health Services Research and Development, Veterans Affairs Pittsburgh Healthcare System and Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, USA

    Carolyn T. Thorpe PhD, MPH

  4. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Jessica R. Schumacher MS, PhD, Mari Palta PhD & Maureen A. Smith MD, PhD, MPH

  5. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Mari Palta PhD

  6. Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Nancy Pandhi MD, MPH, PhD & Maureen A. Smith MD, PhD, MPH

  7. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Maureen A. Smith MD, PhD, MPH

  8. Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248, 600 Highland Avenue, Madison, WI, 53792, USA

    Heather M. Johnson MD, MS

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  1. Heather M. Johnson MD, MS
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Correspondence to Heather M. Johnson MD, MS.

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Johnson, H.M., Thorpe, C.T., Bartels, C.M. et al. Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use. J GEN INTERN MED 29, 723–731 (2014). https://doi.org/10.1007/s11606-014-2790-4

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  • DOI: https://doi.org/10.1007/s11606-014-2790-4

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