(B-150) Determinants Associated with Use of Angiotensin II Inhibiting vs Angiotensin II Stimulation Antihypertensive Medications among Medicare Beneficiaries

Background: Antihypertensive medications are proposed to reduce dementia. Dementia risk has been compared between angiotensin II inhibiting drugs (AIDs) vs. angiotensin II stimulating drugs (ASDs) using claims data, which lack important determinants such as socioeconomic factors (e.g., marital status) and health-related behaviors (e.g., obesity). Whether these factors along with others are associated with use of AIDs vs. ASDs remains unclear.

Objectives: This cohort study examined a wide range of determinants for use of ASDs vs. AIDs among nationally representative U.S. older adults participating in the Health Retirement Study (HRS) with linkage of Medicare data from 2008-2020.

Methods: HRS-Medicare participants ≥65 years with hypertension and at least in one HRS wave during 2008-2020 were included. Inclusion criteria included continuous enrollment in Medicare Part D between one year before (baseline) and two years after each wave and having ≥two prescriptions for ASDs or AIDs two years after each wave. Determinants, assessed from HRS-Medicare data at baseline, included demographic characteristics, socioeconomic factors (marital status, education, household income), health-related behaviors (alcohol use, smoking history, physical activity, body mass index, receipt of cholesterol test screening or preventive dental and flu vaccination care), HRS-assessed comorbidities and health care utilization, and use of anticholinergics, statins, and non-steroidal anti-inflammatory drugs. Treatment outcome, assessed at the 2-year interval, was classified into use of ASD only, AID only (reference), mixed-use (ASD+AID), or no use of ASDs or AIDs. We used multinomial logistic regression to examine the determinants of use of the four treatment groups.

Results: We identified 22,483 episodes from 7,838 HRS-Medicare participants. Of these participants, 21% used ASDs, 28% used AIDs, 23% had mixed-use, and 38% had no use of either drug. Participants with ASDs vs AIDs were more likely to be aged ≥ 85 years (prevalence rate ratio [PRR]=1.3, 95% CI:1.1, 1.7), female (PRR=1.4, 95% CI:1.2, 1.6), Black (PRR=1.7, 95% CI:1.4, 2), and US South residents (PRR=1.2, 95% CI:1.1, 1.5). Users of ASDs vs. AIDs were more likely to be separated/divorced (PRR=1.3, 95% CI:1.1, 1.6) and have less than high school education (PRR=1.3, 95% CI:1.1, 1.5). Other determinants associated with ASDs vs. AIDs included obesity, regular cholesterol screening, food insecurity, stroke, and provider visits.

Conclusions: Using the HRS-linked Medicare data, we identified a variety of determinants, wider than prior studies, associated with the use of ASDs vs. AIDs. These identified determinants may inform future studies examining the effectiveness of AIDs vs. ASDs use on dementia risk.