Prescription patterns of diuretics in Dutch community‐dwelling elderly patients

Abstract

Aims To describe age-and gender-related prescription patterns of diuretics in community-dwelling elderly, and to compare diuretics to other cardiovascular (CV) medications. Methods Cross-sectional study of patient-specific prescription data derived from a panel of 10 Dutch community pharmacies. Determination of proportional prescription rates and prescribed daily dose (PDD) of diuretics, cardiac glycosides, nitrates, angiotensin converting enzyme (ACE) inhibitors, b-adrenoceptor blockers, and calcium channel blockers in all 5326 patients aged 65 years or older dispensed CV medications between August 1st, 1995 and February 1st, 1996. Results Diuretics were prescribed to 2677 of 5326 patients (50.3%), 1325 patients (24.9%) using thiazides and 1198 patients (22.5%) using loop diuretics. Prescription rates of loop diuretics increased from 15.1% in patients aged 65-74 years to 37.2% in patients aged 85 years or older. Rates also increased for digoxin and nitrates. Rates for thiazide diuretics remained unchanged with age; rates for b-adrenoceptor blockers, ACE inhibitors and calcium channel blockers declined with age. Thiazides were prescribed to 30.1% of women compared with 16% of men ( P<0.001). Average PDD was 135±117% of defined daily dose (DDD) for loop diuretics, and highest for bumetanide (245±2.01% of DDD, equivalent to 2.5±2.0 mg). Average PDD was 74±40% of DDD for thiazides, and highest for chlorthalidone (100±49% of DDD, equivalent to 25±12 mg). Conclusions Important characteristics of diuretic usage patterns in this elderly population were a steep increase in loop diuretic use in the oldest old, a large gender difference for thiazide use, and high prescribed doses for thiazides.

Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study

“…In the treatment of congestive heart failure, diuretic drugs are a cornerstone of therapy. Up to 50% of an elderly population in industrialized nations will undergo long-term diuretic treatment [1]. Diuretic therapy is associated with the loss of water soluble vitamins, including vitamin B 1 (thiamine) [2][3][4].…”

Use of attention‐deficit/hyperactivity disorder medication among older adults in Denmark

“…A hospital diagnosis of cancer was registered in 93% of people dying within 1 year after initiating treatment. Among the remaining 7% of individuals dying within the 1 st year, we found more frequent use of loop‐diuretics and antithrombotic agents as a possible indicator of frailty .…”

Prevalence, prescribing and barriers to effective management of hypertension in older populations: a narrative review

“…[ 19 , 20 , 38 – 40 ]. There are a number of possible explanations for this change in the pattern of thiazide prescribing including increased use of other diuretics, particularly in elderly with complicated hypertension [ 41 , 42 ], the advent of other antihypertensive medications such as Calcium Channel Blockers (CCBs) or agents acting on the Renin Angiotensin System (RAS), as well as greater caution by prescribers due to increased risk of adverse drug reactions in elderly [ 43 , 44 ]. Yet, despite this general decline in thiazide use among older persons with hypertension, their use remains high [ 15 , 45 , 46 ], and they are the most commonly used agents in combination therapy in the management of hypertension.…”