{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:07:59Z","timestamp":1787616479860,"version":"build-2736575974"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG74989"],"award-info":[{"award-number":["R01AG74989"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Initial combination therapy has been recommended for patients with high blood pressure (BP). We evaluated annual trends in initial combination therapy and post-treatment BP in Kaiser Permanente Southern California, an integrated healthcare system that adopted combination therapy in 2005.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This serial cross-sectional study included patients newly initiating antihypertensive therapy from 2008 to 2024. We calculated annual age- and sex-standardized proportion of patients initiating combination therapy. Prevalence ratios (PR) of achieving post-treatment BP &amp;lt;140\/90 and &amp;lt;130\/80 mm Hg between 6 and 12 months were estimated for initial combination versus monotherapy adjusting for demographic and pre-treatment BP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 221,384 patients, the use of initial combination therapy increased from 39% in 2008 to 45% in 2011 (p-trend=0.009), then decreased to 27% in 2024 (p-trend &amp;lt;0.001). The decreasing trend of initial combination therapy from 2011 to 2024 was consistent across all pre-treatment systolic BP levels: 130-139 mm Hg (33% to 20%), 140-149 mm Hg (42% to 22%), 150-159 mm Hg (49% to 29%), and \u2265160 mm Hg (61% to 36%). Post-treatment BP &amp;lt;140\/90 mm Hg was 75% in 2011 and 66% in 2024; BP &amp;lt;130\/80 mm Hg was 35% in 2011 and 25% in 2024. PRs for initial combination versus monotherapy were 1.09 (95% CI 1.08, 1.10) for post-treatment BP &amp;lt;140\/90 mm Hg and 1.31 (95% CI 1.29, 1.33) for &amp;lt;130\/80 mm Hg.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although initial combination therapy remains associated with improved BP control, its use has declined in recent years, underscoring the importance of sustained support for guideline concordant care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf248","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T12:54:09Z","timestamp":1766494449000},"page":"787-796","source":"Crossref","is-referenced-by-count":2,"title":["Trends in Initial Combination Antihypertensive Therapy in a US Health System"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3161-5732","authenticated-orcid":false,"given":"Jaejin","family":"An","sequence":"first","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, CA,","place":["United States"]},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine , Pasadena, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, CA,","place":["United States"]},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. 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Tyson School of Medicine , Pasadena, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey W","family":"Brettler","sequence":"additional","affiliation":[{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine , Pasadena, CA,","place":["United States"]},{"name":"Department of Internal Medicine, Kaiser Permanente West Los Angeles Medical Center , Los Angeles, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeline L","family":"Ong-Su","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Kaiser Permanente Panorama City Medical Center , Panorama City, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine G","family":"Derington","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Colorado School of Medicine , Aurora, CO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhe","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology, University of Utah , Salt Lake City, UT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam P","family":"Bress","sequence":"additional","affiliation":[{"name":"Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine, University of Utah , Salt Lake City, UT,","place":["United States"]},{"name":"George E. 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