Abstract Body (Do not enter title and authors here): Introduction: It is unknown how often beta blockers (BB) are used first line for high blood pressure (BP) treatment among patients without compelling indications, despite US BP guidelines not recommending this practice since 2014.
Research Question: How many start, and what factors influence, first line BB use among patients without compelling indications?
Methods: Serial cross-sectional study of outpatients newly diagnosed and initiating treatment in the Veterans Health Administration, 1/1/2000–12/31/2022. We removed prevalent users, categorized drugs by class, and presented compelling indication status by initial BB use (mono- or combination therapy). Among those without compelling indications (ie, aortic aneurysm/disease, angina, atrial fibrillation/tachyarrhythmia, chronic liver disease/cirrhosis, heart failure with reduced ejection fraction, myocardial infarction, or coronary revascularization), multivariable Poisson regression estimated factors associated with BB use.
Results: Of 3138304 Veterans (mean age 61 years, 94% male, 65% Non-Hispanic White), 774821 (25%) initiated a BB, of which the proportion without compelling indications decreased over time from 91% to 81%; the proportion with compelling indications increased from 9% to 19% (Panel A). Specific BBs used changed over time (Panel B). Among those without compelling indications, BB initiation was more likely with increasing age, females, current smokers, alcohol abuse, aspirin or statin use, each additional antihypertensive prescribed, each pre-index hospitalization, and urban setting (Panel C).
Conclusions: Most Veterans using BB first line for high BP do not have compelling indications. Interventions are needed to align real world treatments with guidelines.