{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T13:05:40Z","timestamp":1780059940243,"version":"3.54.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,1,3]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Knowledge of real\u2010world antihypertensive use is limited to prevalent hypertension, limiting our understanding of how treatment evolves and its contribution to persistently poor blood pressure control. We sought to characterize antihypertensive initiation among new users.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Using Medicaid and Medicare data from the OneFlorida+ Clinical Research Consortium, we identified new users of \u22651 first\u2010line antihypertensives (angiotensin\u2010converting enzyme inhibitor, calcium channel blocker, angiotensin receptor blocker, thiazide diuretic, or \u03b2\u2010blocker) between 2013 and 2021 among adults with diagnosed hypertension, and no antihypertensive fill during the prior 12\u2009months. We evaluated initial antihypertensive regimens by class and drug overall and across study years and examined variation in antihypertensive initiation across demographics (sex, race, and ethnicity) and comorbidity (chronic kidney disease, diabetes, and atherosclerotic cardiovascular disease). We identified 143\u2009054 patients initiating 188\u2009995 antihypertensives (75% monotherapy; 25% combination therapy), with mean age 59\u2009years and 57% of whom were women. The most commonly initiated antihypertensive class overall was angiotensin\u2010converting enzyme inhibitors (39%) followed by \u03b2\u2010blockers (31%), calcium channel blockers (24%), thiazides (19%), and angiotensin receptor blockers (11%). With the exception of \u03b2\u2010blockers, a single drug accounted for \u226575% of use of each class. \u03b2\u2010blocker use decreased (35%\u201326%), and calcium channel blocker use increased (24%\u201328%) over the study period, while initiation of most other classes remained relatively stable. We also observed significant differences in antihypertensive selection across demographic and comorbidity strata.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">These findings indicate that substantial variation exists in initial antihypertensive prescribing, and there remain significant gaps between current guideline recommendations and real\u2010world implementation in early hypertension care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026652","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T10:36:20Z","timestamp":1671878180000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0201-839X","authenticated-orcid":false,"given":"Steven M.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville FL"},{"name":"Division of Cardiovascular Medicine, Department of Medicine, College of Medicine University of Florida Gainesville FL"},{"name":"Center for Integrative Cardiovascular and Metabolic Disease University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6518-5961","authenticated-orcid":false,"given":"Almut G.","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3371-4582","authenticated-orcid":false,"given":"Matthew J.","family":"Gurka","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0266-3612","authenticated-orcid":false,"given":"Marta G.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9961-2511","authenticated-orcid":false,"given":"Shailina","family":"Keshwani","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4564-9407","authenticated-orcid":false,"given":"Anne M.","family":"Libby","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine University of Colorado Denver Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9881-1017","authenticated-orcid":false,"given":"William R.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6011-681X","authenticated-orcid":false,"given":"Carl J.","family":"Pepine","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, College of Medicine University of Florida Gainesville FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5198-130X","authenticated-orcid":false,"given":"Rhonda M.","family":"Cooper\u2010DeHoff","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, College of Medicine University of Florida Gainesville FL"},{"name":"Center for Integrative Cardiovascular and Metabolic Disease University of Florida Gainesville FL"},{"name":"Department of Pharmacotherapy and Translational Research, College of Pharmacy University of Florida Gainesville 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