Factors Associated with Antihypertensive Therapy Prescription in Youth Delaware Medicaid Recipients with Primary Hypertension Diagnosis

• Published in: American journal of hypertension 2024-01, Vol.37 (2), p.143-149
• Main Authors: Baker-Smith, Carissa M, McDuffie, Mary J, Nescott, Erin P, Akins, Robert E
• Format: Article
• Language: English
• Subjects: Adolescent; Antihypertensive Agents - therapeutic use; Cross-Sectional Studies; Delaware - epidemiology; Essential Hypertension - drug therapy; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - epidemiology; Medicaid; Obesity - drug therapy; Original Contributions; Prescriptions; Retrospective Studies; United States - epidemiology
• ISSN: 0895-7061; 1941-7225; 1941-7225
• DOI: 10.1093/ajh/hpad098

Abstract BACKGROUND Higher neighborhood deprivation is associated with hypertension diagnosis in youth. In this study, we assess if there is an association between neighborhood deprivation and antihypertensive therapy prescription among insured youth with a primary hypertension diagnosis. METHODS Using a retrospective cross-sectional design, we assessed the proportion of youth with a diagnosis of primary hypertension prescribed antihypertensive therapy. We evaluated the proportion of youth prescribed antihypertensive therapy and compared prescribing patterns by area deprivation index (ADI), age, sex, obesity diagnosis, race, ethnicity, and duration of Medicaid coverage. RESULTS Of the 65,452 non-pregnant Delaware Medicaid recipients, 8–18 years of age, 1,145 (1.7%) had an International classification of diseases (ICD)-9/ICD-10 diagnosis of primary hypertension; 165 of the 1,145 (14%) were prescribed antihypertensive therapy. Factors associated with a greater odds of prescription by multivariable logistic regression were age, obesity diagnosis, and duration of Medicaid full benefit coverage. Odds of antihypertensive therapy prescription did not vary by race, ethnicity, or ADI. CONCLUSIONS Antihypertensive therapy prescription rates are poor despite national guideline recommendations. Among youth receiving Delaware Medicaid between 2014 and 2019, prescription proportions were highest among youth of older age, with an obesity diagnosis, and among youth with longer duration of Medicaid benefit coverage. Although high area deprivation has been shown to be associated with the diagnosis of hypertension, high vs. low area deprivation was not associated with greater antihypertensive therapy prescription among youth with primary hypertension. Our finding of a mismatch between hypertension diagnosis and antihypertensive therapy prescription highlights a potential disparity in antihypertensive therapy prescription in youth. Graphical Abstract The primary drivers of antihypertensive therapy prescription include older age, longer duration of full Medicaid benefit coverage and obesity diagnosis.