ACE and ARB Treatment among Medicare Beneficiaries with Diabetes and Hypertension

Between 2000 and 2010, the percentage of patients aged ≥65 years with diabetes and hypertension increased from 9% to 15%. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have proven to decrease the risk of cardiovascular disease, reduce the progression of nephropathy, and are recommended for patients with diabetes and hypertension.

However, the number of diabetes and hypertension patients receiving ACE/ARB is significantly low. Since the implementation of Medicare Part D, there has been an increase in medication usage. It is crucial to determine the status of patients receiving ACE/ARB post-Medicare Part D implementation. To determine this, the rate of Medicare beneficiaries with diabetes and hypertension receiving ACE/ARB in the physician’s office and outpatient locations were assessed in a recent study [J Pharm Health Serv Res. 2014;5(1):67-74].

The data were collected between 2007 and 2009 by the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey Out Patient Department. Patients included in the study were Medicare beneficiaries with diabetes and hypertension who were expected to utilize Medicare as their primary source of payment.

The characteristics of patients measured in this study were age, gender, race, type of insurance, education level, income level, region of residency, metropolitan statistical area, and whether the provider was a primary care physician (PCP). Education level was defined as the percentage of people with a bachelor’s degree or higher in the patient’s state zip code and was distributed as follows: ≤12.83%, 12.84% to 19.66%, 19.67% to 31.68%, and ≥31.69%. The income level was categorized by the mean income for the zip code in which the patient lives. The income levels were categorized as: ≤$32,793, $32,794 to $40,626, $40,627 to $52,387, and ≥$52,388.

There were 6311 visits recorded from Medicare beneficiaries with diabetes and hypertension. A total of 42.19% of patients in the study were between the ages of 65 and 74 years. Most patients did not have private insurance (60.8%), and a majority of patients had Medicaid (88.93%). Medicare beneficiaries who lived in the lowest education level zip codes (≤12.83%) made up the most visits (29.49%). Patients in the 12.84% to 19.66% education level range accounted for 27.15% of study participants.

A total of 40.7% received ACE/ARB. The study found that higher proportions of ACE/ARB were prescribed to patients during visits to their PCPs compared with non-PCPs (48.39% vs 32.56%; P<.05). Also, patients living in an area where the income level is within the $32,794 to $40,626 range were more likely to receive ACE/ARBs than patients residing in <$32,793 faction (odds ratio, 1.45; 95% confidence interval, 1.13-1.87,). No other characteristics of patients showed significance in whether or not they received ACE/ARB.