Published Online
on April 25, 2005

A more recent version of this article appeared on June 1, 2005

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Submitted on January 19, 2005
Revised on February 12, 2005

Hypertension Management in the Elderly Has Improved. Ontario Prescribing Trends, 1994 to 2002

Karen Tu; Norman R.C. Campbell; Minh Duong-Hua; and Finlay A. McAlister^*

From the Institute for Clinical Evaluative Sciences, Toronto, Canada (K.T., M.D.-H.); University Health Network, Toronto Western Hospital Family Medicine Centre (K.T.); University of Toronto, Canada, Departments of Family and Community Medicine, Family Healthcare Research Unit (K.T.); University of Calgary, Canada, Departments of Medicine and Pharmacology, and Therapeutics (N.R.C.C.); and University of Alberta, Division of General Internal Medicine (F.A.M.), Canada.

^* To whom correspondence should be addressed. E-mail: Finlay.McAlister{at}ualberta.ca.

Abstract--To examine whether the treatment of elderly hypertensives had become more aggressive over the past decade, we evaluated: (1) the frequency of new prescriptions for hypertension treatment, adjusted by age and gender; (2) the frequency with which multiple antihypertensives were prescribed concurrently within 2 years of initial diagnosis; and (3) discontinuation rates for antihypertensive therapy. We linked 4 administrative databases and a province-wide clinical database in Ontario, Canada, to derive a cohort of patients 66 years of age who were newly started on an antihypertensive agent between July 1, 1994, and March 31, 2002, without another indication for the agent (all patients were followed for 2 years after their initial antihypertensive prescription). Our cohort consisted of 196 451 people newly started on antihypertensive therapy, 30 433 of whom also had diabetes mellitus. The population-adjusted rate of new antihypertensive prescriptions increased by 30% between 1994 and 2002. Whereas 21% of patients newly diagnosed with hypertension in 1994 were prescribed multiple antihypertensives concurrently within 2 years of diagnosis, this proportion had increased to 40% by 2002 (P<0.0001). In the cohort of patients first prescribed an antihypertensive in 1994, 36% were not taking any antihypertensive within 2 years; only 21% of patients first prescribed an antihypertensive in 2002 had discontinued all therapy within 2 years (P<0.0001). Our data provide evidence that the physician management of hypertension in elderly Canadians became more aggressive between 1994 and 2002.

Key words: hypertension, essential • drug therapy • prospective studies • elderly

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