Trends in first‐line monotherapy and combination therapy for hypertension in UK primary care
Bibliographic record
Abstract
AIMS: Debate remains about the optimal initial treatment strategy for hypertension. Most guidelines recommend first-line combination therapy for most patients. However, the UK's National Institute for Health and Care Excellence recommends first-line monotherapy for all patients. It is unknown if first-line combination therapy use is increasing despite this recommendation. This study aims to assess trends in prescriptions for first-line antihypertensive monotherapy and combination therapy in UK primary care. METHODS: Using the Clinical Practice Research Datalink, we formed a cohort of all patients newly diagnosed with hypertension between 2011 and 2019. We calculated annual proportions of patients newly prescribed first-line monotherapy and combination therapy within 3 months of diagnosis. We used Kaplan-Meier methods to estimate the median treatment persistence, and the probability of persistence at 6 months and 1 year for mono- and combination therapy. RESULTS: Among 535 234 patients with hypertension, 1.7% received first-line combination therapy, while 85.6% received monotherapy. Rates of initiation varied by age and hypertension stage. Median treatment persistence was 298 (95% confidence interval [CI] 276-318) days on first-line combination therapy, compared to 398 (95% CI 394-403) days on monotherapy. At 6 months, 58.2% (95% CI 57.2%-59.3%) of combination therapy and 62.2% (95% CI 62.1%-62.4%) of monotherapy initiators remained on first-line treatment; at 1 year the numbers fell to 46.4% (95% CI 45.4%-47.6%) and 51.2% (95% CI 51.1%-51.4%), respectively. CONCLUSIONS: First-line antihypertensive combination therapy remains exceedingly rare in the UK in accordance with National Institute for Health and Care Excellence guidelines, but in contrast to other international recommendations. Treatment persistence was lower on first-line combination therapy than monotherapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".