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CHRISTOPHER H. YOUNG, PH.D., is Director; and KUI ZHANG, M.D., is Manager, Caremark, Hunt Valley, MD. AMY W. PORET, M.S., is Health Economist, Boehringer Ingelheim, Ridgefield, CT.

Address correspondence to Dr. Young at Caremark Inc., One Hunt Valley, 11311 McCormick Road, Suite 230, Hunt Valley, MD 21031 (christopher.young{at}caremark.com).

Purpose. The patterns of angiotensin II-receptor blocker (ARB) therapy in patients with and without a history of antihypertensive use were studied. Methods. Data for this retrospective cohort study were obtained from Caremark’s data warehouse. Patients were included in the analysis if they filled prescriptions for ARBs only, did not receive ARB therapy within the 6 months before the filling of the first ARB prescription (index date), were continuously eligible for benefits for 6 months before the index date, were eligible for prescription benefits for the 12 months following the index date, and were age 20–80 years. Results. Of the 174,573 patients sampled, 53.4% were new to all antihypertensive therapies. Of the patients receiving an ARB, 67.9% received another antihypertensive during the evaluation period. Over 40% of patients new to all antihypertensive therapies had no other antihypertensive added to their ARB regimen. Of the patients with a history of antihypertensive use, 22.3% discontinued all antihypertensives before starting therapy with an ARB. Patients starting therapy with losartan and valsartan were less likely to be treated with mono-therapy and more likely to be treated with ARB–diuretic therapy than were patients starting therapy with telmisartan, irbesartan, or candesartan. Conclusion. Patients who started antihypertensive therapy with ARBs tended to be new to antihypertensive therapy and, in a plurality of cases, continued to receive therapy with ARBs only. More than a fifth of patients who received antihypertensive therapy in the recent past were switched from that therapy to treatment with ARBs only. Treatment patterns differed by initial ARB used and the demographic profile of the patient. Index terms: Angiotensin antagonists; Candesartan; Combined therapy; Diuretics; Drug use; Hypertension; Irbesartan; Losartan; Telmisartan; Valsartan