Trends in Pediatric Blood Pressure–Lowering Prescription Fills During 2017–2023

TL;DR

Blood pressure-lowering prescriptions for U.S. children increased slightly from 2017 to 2023, with the biggest rise among teenage girls, and the increase was driven by medications not recommended in a major guideline.

Contribution

The study provides the first national estimates of pediatric blood pressure-lowering prescription trends and highlights the use of non-guideline medications.

Findings

Prescription fills for blood pressure-lowering medications increased from 1.9% to 2.1% among U.S. children aged 3–17 years from 2017 to 2023.

Females aged 13–17 years had the sharpest increase in prescription fills (40.3%) during the study period.

The rise in prescriptions was driven by medications not included in the 2017 American Academy of Pediatrics guideline.

Abstract

•Data on blood pressure–lowering prescription fills among U.S. children are scarce.•From 2017 to 2023, fills among those aged 3–17 years increased from 1.9% to 2.1%.•Fills remained stable among males and increased among females.•Females aged 13–17 years experienced the sharpest increase (40.3%).•Increases were driven by medications not included in the 2017 American Academy of Pediatrics guideline.

Data on blood pressure–lowering prescription fills among U.S. children are scarce.

From 2017 to 2023, fills among those aged 3–17 years increased from 1.9% to 2.1%.

Fills remained stable among males and increased among females.

Females aged 13–17 years experienced the sharpest increase (40.3%).

Increases were driven by medications not included in the 2017 American Academy of Pediatrics guideline.

There are no national estimates for blood pressure–lowering prescription trends among the U.S. pediatric population. This study describes trends in blood pressure–lowering prescription fills among individuals aged 3–17 years by sex and age group.

Data were obtained from IQVIA’s Total Patient Tracker database covering 94% of all outpatient retail prescription fills in the U.S. The key outcome was blood pressure–lowering prescription fills during 2017–2023, utilizing a list of 113 generic medications from 21 drug classes. In addition, a subset of 20 medications recommended in the 2017 American Academy of Pediatrics guideline was examined. Annual population percentage and percentage change compared with 2017 were reported, and average annual percentage change was estimated using Joinpoint regression.

From 2017 to 2023, blood pressure–lowering prescription fills among those aged 3–17 years increased slightly from 1.93% (95% CI=1.88%, 1.98%) to 2.09% (95% CI=2.04%, 2.14%). Among males, blood pressure–lowering prescription fills remained stable (between 2.32% and 2.38%; average annual percentage change= −0.3%; p=0.545), whereas fills among females increased by 23.9% (from 1.49% to 1.84%; average annual percentage change=4.16%; p<0.001). The sharpest increase occurred among females aged 13–17 years (from 2.26% to 3.17%; average annual percentage change=6.3%; p<0.001). Prescription fills for guideline-recommended medications either remained stable or declined, with some variation by sex and age group.

Results indicate growth in blood pressure–lowering prescription fills, especially among females aged 13–17 years. Increases were driven by medications not included in the 2017 American Academy of Pediatrics guideline, suggesting that blood pressure–lowering medications may be increasingly prescribed for conditions other than pediatric hypertension.

Figures