{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:31:50Z","timestamp":1786977110659,"version":"build-2736575974"},"reference-count":55,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:00:00Z","timestamp":1757721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:00:00Z","timestamp":1757721600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Debate remains about the optimal initial treatment strategy for hypertension. Most guidelines recommend first\u2010line combination therapy for most patients. However, the UK's National Institute for Health and Care Excellence recommends first\u2010line monotherapy for all patients. It is unknown if first\u2010line combination therapy use is increasing despite this recommendation. This study aims to assess trends in prescriptions for first\u2010line antihypertensive monotherapy and combination therapy in UK primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the Clinical Practice Research Datalink, we formed a cohort of all patients newly diagnosed with hypertension between 2011 and 2019. We calculated annual proportions of patients newly prescribed first\u2010line monotherapy and combination therapy within 3\u00a0months of diagnosis. We used Kaplan\u2013Meier methods to estimate the median treatment persistence, and the probability of persistence at 6\u00a0months and 1 year for mono\u2010 and combination therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 535\u2009234 patients with hypertension, 1.7% received first\u2010line combination therapy, while 85.6% received monotherapy. Rates of initiation varied by age and hypertension stage. Median treatment persistence was 298 (95% confidence interval [CI] 276\u2013318) days on first\u2010line combination therapy, compared to 398 (95% CI 394\u2013403) days on monotherapy. At 6\u00a0months, 58.2% (95% CI 57.2%\u201359.3%) of combination therapy and 62.2% (95% CI 62.1%\u201362.4%) of monotherapy initiators remained on first\u2010line treatment; at 1 year the numbers fell to 46.4% (95% CI 45.4%\u201347.6%) and 51.2% (95% CI 51.1%\u201351.4%), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>First\u2010line antihypertensive combination therapy remains exceedingly rare in the UK in accordance with National Institute for Health and Care Excellence guidelines, but in contrast to other international recommendations. Treatment persistence was lower on first\u2010line combination therapy than monotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bcp.70271","type":"journal-article","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T12:30:54Z","timestamp":1757766654000},"page":"457-467","source":"Crossref","is-referenced-by-count":1,"title":["Trends in first\u2010line monotherapy and combination therapy for hypertension in UK primary care"],"prefix":"10.1002","volume":"92","author":[{"given":"Kyle","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University  Montreal Canada"},{"name":"Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research Jewish General Hospital  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Beradid","sequence":"additional","affiliation":[{"name":"Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research Jewish General Hospital  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Brophy","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University  Montreal Canada"},{"name":"Department of Medicine McGill University  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Platt","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University  Montreal Canada"},{"name":"Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research Jewish General Hospital  Montreal Canada"},{"name":"Department of Pediatrics McGill University  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4691-9579","authenticated-orcid":false,"given":"Christel","family":"Renoux","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University  Montreal Canada"},{"name":"Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research Jewish General Hospital  Montreal Canada"},{"name":"Department of Medicine McGill University  Montreal Canada"},{"name":"Department of Neurology and Neurosurgery McGill University  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581\u2010019\u20100244\u20102"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X708053"},{"issue":"7705","key":"e_1_2_10_4_1","first-page":"1245","article-title":"Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta\u2010analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies","volume":"338","author":"Law MR","year":"2009","journal-title":"BMJ"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)01225\u20108"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511939"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.3.329"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.3322"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.318083"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.19590"},{"issue":"6","key":"e_1_2_10_11_1","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and Management of High Blood Pressure in adults: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"71","author":"Whelton PK","year":"2018","journal-title":"Hypertension"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15026"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.12857"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.12858"},{"key":"e_1_2_10_16_1","volume-title":"Hypertension in adults: diagnosis and management [E] evidence review for step 1 treatment [internet]. 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