This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Monane, M. Articles by Avorn, J. Search for Related Content PubMed PubMed Citation Articles by Monane, M. Articles by Avorn, J. Pubmed/NCBI databases Medline Plus Health Information Blood Pressure Medicines High Blood Pressure

(Hypertension. 1995;25:1045-1051.)
© 1995 American Heart Association, Inc.

Articles

Trends in Medication Choices for Hypertension in the Elderly

The Decline of the Thiazides

Mark Monane; Robert J. Glynn; Jerry H. Gurwitz; Rhonda L. Bohn; Raisa Levin; Jerry Avorn

From the Program for the Analysis of Clinical Strategies, Gerontology Division, and the Preventive Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; and the Claude Pepper Geriatric Research and Training Center, Harvard Medical School, Boston, Mass.

Correspondence to Mark Monane, MD, MS, Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115.

Abstract We studied the evolution in choice of antihypertensive therapy in the elderly over a seven-year period and defined factors associated with such prescribing. To accomplish this, we performed a retrospective analysis of 8428 enrollees older than 65 years of age in the New Jersey Medicaid and Medicare programs newly begun on antihypertensive therapy between 1982 and 1988. Diuretics were the most common agents prescribed (51%), followed by calcium channel blockers (14%), ß-blockers (13%), central adrenergic antagonists (11%), and angiotensin-converting enzyme inhibitors (5%). However, the use of diuretics declined sharply during the latter part of the time interval studied. Using logistic regression modeling, we determined that the odds of a subject being started on a diuretic compared with any other antihypertensive drug decreased from 1.0 during the referent years 1982 to 1984 to 0.75 in 1985 to 1986 and to 0.41 in 1987 to 1988, after controlling for demographics, comorbidity, and hospital and physician visits (P<.001). The relative odds of diuretic use were significantly increased (P<.05) for the oldest subjects (odds ratio, 1.28 for age 85 and older versus ages 65 to 74 odds), women (odds ratio, 1.15), and blacks (odds ratio, 1.14). Despite the growing evidence during the study interval of the efficacy of diuretics in treating hypertension in the elderly, diuretic use diminished throughout this period in relation to other antihypertensive drugs. Subject characteristics (oldest subjects, women, and blacks) were important determinants of physicians' choice of antihypertensive therapy.

Key Words: aging • antihypertensive agents • diuretics • elderly • epidemiology

This article has been cited by other articles:

				A. S. Kesselheim and J. Avorn Pharmaceutical Promotion to Physicians and First Amendment Rights N. Engl. J. Med., April 17, 2008; 358(16): 1727 - 1732. [Full Text] [PDF]

				J. L. Milchak, B. L. Carter, P. A. James, and G. Ardery Measuring Adherence to Practice Guidelines for the Management of Hypertension: An Evaluation of the Literature Hypertension, November 1, 2004; 44(5): 602 - 608. [Abstract] [Full Text] [PDF]

				B. M. Psaty, T. A. Manolio, N. L. Smith, S. R. Heckbert, J. S. Gottdiener, G. L. Burke, J. Weissfeld, P. Enright, T. Lumley, N. Powe, et al. Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults: The Cardiovascular Health Study Arch Intern Med, November 11, 2002; 162(20): 2325 - 2332. [Abstract] [Full Text] [PDF]

				M. A. Espeland, P. K. Whelton, J. B. Kostis, J. L. Bahnson, W. H. Ettinger, J. A. Cutler, L. J. Appel, S. Kumanyika, D. Farmer, J. Elam, et al. Predictors and Mediators of Successful Long-term Withdrawal From Antihypertensive Medications Arch Fam Med, May 1, 1999; 8(3): 228 - 236. [Abstract] [Full Text] [PDF]

				G. Gambassi, K. Lapane, A. Sgadari, F. Landi, P. Carbonin, A. Hume, L. Lipsitz, V. Mor, R. Bernabei, and for the SAGE Study Group Prevalence, Clinical Correlates, and Treatment of Hypertension in Elderly Nursing Home Residents Arch Intern Med, November 23, 1998; 158(21): 2377 - 2385. [Abstract] [Full Text] [PDF]

				W. H. Barker, J. P. Mullooly, and K. L. P. Linton Trends in Hypertension Prevalence, Treatment, and Control In a Well-Defined Older Population Hypertension, January 1, 1998; 31(1): 552 - 559. [Abstract] [Full Text] [PDF]

				M. Monane, D. S. Kanter, R. J. Glynn, and J. Avorn Variability in Length of Hospitalization for Stroke: The Role of Managed Care in an Elderly Population Arch Neurol, September 1, 1996; 53(9): 875 - 880. [Abstract] [PDF]

				J. E. Buring, R. J. Glynn, and C. H. Hennekens Calcium Channel Blockers and Myocardial Infarction: A Hypothesis Formulated but Not Yet Tested JAMA, August 23, 1995; 274(8): 654 - 655. [Abstract] [PDF]

				Prescribing Patterns Shift to Expensive Nonthiazide Diuretics Journal Watch Cardiology, June 1, 1995; 1995(601): 8 - 8. [Full Text]