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 medic ation utilization, distributed by medication classes, associated with the F ifth Report of the Joint National Committee (JNC V) guideline changes and t he Department of Defense Pharmacoeconomic Center's recommendations to follo w JNC V guidelines in presumed newly treated hypertensive patients. DESIGN: A 43-month, longitudinal, retrospective analysis using data from th e Department of Defense Uniformed Services Prescription Database. SETTING: Seven outpatient US military sites. PATIENTS: Eligible patients (n = 7277) included those from seven military s ites, aged 20-49 years, who were: (1) active-duty members of the US Armed F orces, (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 follow ing four medication classes: angiotensin-converting enzyme inhibitors, P-bl ockers, calcium-channel blockers, and diuretics. RESULTS: Segmented time series analyses revealed no significant differences in utilization of the four medication classes that corresponded to publish ed guidelines outlining initial antihypertensive therapy. CONCLUSIONS: it appeared that JNC V guidelines and recommendations of the P harmacoeconomic Center to follow JNC V had little effect on the utilization of prescription medication classes studied.