Predictors of fixed-dose combination antihypertensive drug therapy in a Medicaid population

Physicians may prescribe hypertension combination therapy, either with fixed-dose combination therapy or with dual-agent component-based therapy. This study evaluated the predictors of hypertensive patients receiving either type of combination therapy. Our study was based on claims data from the Maryland Medicaid Managed Care Organizations. Patients had exclusively used either fixed-dose combination therapy or dual-agent component-based therapy. We used multivariate logistic regression to estimate the impact of age, gender, race, comorbidities, and specific managed care organizations on the likelihood of receiving dual-agent component-based therapy vs. fixed-dose combination therapy. Of a total 2,483 study subjects, 1,270 received dual-agent component-based therapy and 1,213 received fixed-dose combination therapy. Compared with the reference group (Americaid Community Care), Maryland Physicians Care was three times more likely to prescribe dual-agent component-based therapy for its enrollees (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.24 – 4.05). United Healthcare and other managed care organizations were 37% and 57% more likely to have dual-agent component-based therapy than the reference group, respectively (OR, 1.37; 95% CI, 1.08 – 1.74 and OR, 1.57; 95% CI, 1.16 – 2.14). In conclusion, significant prescribing variations exist across managed care organizations. Sickly male patients were more likely to receive the dual-agent component-based therapy. This information can assist future plans in medication therapy management.