Trends in antihypertensive drugs in the elderly: the decline of thiazides

Abstract

The last decade has seen the publication of different editions of guidelines for the pharmacological treatment of hypertension that were based on the results of large, randomised trials. Since these guidelines were meant to inform practitioners, we analysed the pattern of prescription of antihypertensive agents between 1988 and 1997 among older hospitalised adults. Because of the wealth of data supporting the use of thiazides diuretics, we focused on diuretic prescription, to identify independent predictors of their utilisation. To this end, we used the GIFA database that includes patients admitted to academic medical centres throughout Italy between 1988 and 1997. We studied 5061 patients over 65 years of age selected among a population of 28 411, based on the diagnosis of arterial hypertension at discharge. The use of ACE-inhibitors has been raising steadily through the years, and they are the agents most commonly used since 1996. Calcium channel blockers showed a similar trend and were the top prescribing drug until 1995; afterwards, the documentation of potentially severe side effects has resulted in a nearly 20% reduction of their

Patterns of antihypertensive prescribing, discontinuation and switching among a Hong Kong Chinese population from over one million prescriptions

“…11 Elderly patients in this study were less likely to receive BBs, similarly reported in local and international studies. 7,8 This is in line with guidelines highlighting greater efficacy of thiazide diuretics and CCBs in the elderly with respect to their lower renin status.…”

“…4,5 However, the small size of these studies and that they were self-reported raise questions about accuracy and representativeness. Internationally, patterns and trends in antihypertensive prescribing vary widely between countries [6][7][8][9][10] (Supplementary file 5). Suggested factors to explain inter-country variation included reimbursement policies, traditions, domestic pharmaceutical production and clinical practice guidelines.…”

Treatment of osteoporosis among older adults discharged from hospital in Italy

“…The methods of the GIFA have been described in detail elsewhere [9]. Brie¯y, all patients admitted to 81 clinical centres during two 2-month periods in 1988, 1991, 1993, 1995 and 1997 were enrolled and followed until discharge.…”

Why are thiazide diuretics declining in popularity?

“…However, in the current issue of the Journal of Human Hypertension we publish a paper by Onder and colleagues 4 documenting the rate of decline in the use of thiazide diuretics in Italy. There is every reason to believe that trends are similar elsewhere.…”

“…Onder and co-workers drew attention to this point in the article. 4 Prescribing behaviour is often related to the enthusiasm of the latest speaker at a postgraduate meeting or to good feelings about a particular drug company or its representatives or even the quality of the free lunch. In the field of hypertension where there is such a wide choice of drugs, clinicians are subjected to a great many influences.…”