{"doi":"10.1001/jamanetworkopen.2020.25127","title":"Association of Race/Ethnicity-Specific Changes in Antihypertensive Medication Classes Initiated Among Medicare Beneficiaries With the Eighth Joint National Committee Panel Member Report","abstract":"Importance: In December 2013, the panel members appointed to the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8) published a recommendation that non-Black adults initiate antihypertensive medication with a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB), whereas Black adults initiate treatment with a thiazide-type diuretic or calcium channel blocker. β-Blockers were not recommended as first-line therapy. Objective: To assess changes in antihypertensive medication classes initiated by race/ethnicity from before to after publication of the JNC8 panel member report. Design, Setting, and Participants: This serial cross-sectional analysis assessed a 5% sample of Medicare beneficiaries aged 66 years or older who initiated antihypertensive medication between 2011 and 2018, were Black (n = 3303 [8.0%]), White (n = 34 943 [84.5%]), or of other (n = 3094 [7.5%]) race/ethnicity, and did not have compelling indications for specific antihypertensive medication classes. Exposures: Calendar year and period after vs before publication of the JNC8 panel member report. Main Outcomes and Measures: The proportion of beneficiaries initiating ACEIs or ARBs and, separately, β-blockers vs other antihypertensive medication classes. Results: In total, 41 340 Medicare beneficiaries (65% women; mean [SD] age, 75.7 [7.6] years) of Black, White, or other races/ethnicities initiated antihypertensive medication and met the inclusion criteria for the present study. In 2011, 25.2% of Black beneficiaries initiating antihypertensive monotherapy did so with an ACEI or ARB compared with 23.7% in 2018 (P = .47 for trend). Among beneficiaries initiating monotherapy, the proportion filling a β-blocker was 20.1% in 2011 and 15.4% in 2018 for White beneficiaries (P < .001 for trend), 14.2% in 2011 and 11.1% in 2018 for Black beneficiaries (P = .08 for trend), and 11.3% in 2011 and 15.0% in 2018 for beneficiaries of other race/ethnicity (P = .40 for trend). After multivariable adjustment and among beneficiaries initiating monotherapy, there was no evidence of a change in the proportion filling an ACEI or ARB before to after publication of the JNC8 panel member report overall (prevalence ratio, 1.00; 95% CI, 0.97-1.03) or in Black vs White beneficiaries (prevalence ratio, 0.96; 95% CI, 0.83-1.12; P = .60 for interaction). Among beneficiaries initiating monotherapy, the proportion filling a β-blocker decreased from before to after publication of the JNC8 panel member report (prevalence ratio, 0.89; 95% CI, 0.84-0.93) with no differences across race/ethnicity groups (P > .10 for interaction). Conclusions and Relevance: A substantial proportion of older US adults who initiate antihypertensive medication do so with non-guideline-recommended classes of medication.","journal":"JAMA Network Open","year":2020,"id":68738,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":22,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9562,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":364187,"name":"Jordan B. King","orcid":"0000-0002-6783-7951","position":1,"is_corresponding":false},{"id":295977,"name":"Suzanne Oparil","orcid":"0000-0002-7505-2599","position":2,"is_corresponding":false},{"id":14,"name":"Jackson T. Wright","orcid":"0000-0003-2557-7239","position":3,"is_corresponding":false},{"id":365501,"name":"Gbenga Ogedegbe","orcid":null,"position":4,"is_corresponding":false},{"id":364188,"name":"April F. Mohanty","orcid":"0000-0003-4510-9758","position":5,"is_corresponding":false},{"id":364189,"name":"Shakia T. Hardy","orcid":"0000-0001-9211-0474","position":6,"is_corresponding":false},{"id":364190,"name":"Lei Huang","orcid":"0000-0003-2820-1915","position":7,"is_corresponding":false},{"id":355268,"name":"Rachel Hess","orcid":"0000-0003-2545-8504","position":8,"is_corresponding":false},{"id":74980,"name":"Paul Muntner","orcid":"0000-0002-4711-5492","position":9,"is_corresponding":false},{"id":295963,"name":"Adam P. Bress","orcid":"0000-0002-2259-5039","position":10,"is_corresponding":false},{"id":364186,"name":"Calvin L. Colvin","orcid":"0000-0003-0323-2029","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-18T21:41:52.279368Z","pmid":"33206191","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}