A comparison of antihypertensive medication utilization before and after guideline changes using the Department of Defense Prescription Database

OBJECTIVE: To determine changes in the proportion of antihypertensive medication utilization, distributed by medication classes, associated with the Fifth Report of the Joint National Committee (JNC V) guideline changes and the Department of Defense Pharmacoeconomic Center's recommendations to follow JNC V guidelines in presumed newly treated hypertensive patients. DESIGN: A 43-month, longitudinal, retrospective analysis using data from the Department of Defense Uniformed Services Prescription Database. SETTING: Seven outpatient US military sites. PATIENTS: Eligible patients (n = 7277) included those from seven military sites, aged 20-49 years, who were: (1) active-duty members of the US Armed Forces, (2) active-duty members' family members, (3) retired members of the US Armed Forces, and (4) US Armed Forces retired members' family members. MAIN OUTCOME MEASURE: Proportion of antihypertensive medication utilization, distributed by medication class over the 43-month study period. METHODOLOGY: Segmented time series analysis was used for each of the following four medication classes: angiotensin-converting enzyme inhibitors, beta-blockers, calcium-channel blockers, and diuretics. RESULTS: Segmented time series analyses revealed no significant differences in utilization of the four medication classes that corresponded to published guidelines outlining initial antihypertensive therapy. CONCLUSIONS: It appeared that JNC V guidelines and recommendations of the Pharmacoeconomic Center to follow JNC V had little effect on the utilization of prescription medication classes studied.