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First-line first? Trends in thiazide prescribing for hypertensive seniors
Steve Morgan1, Kenneth L Bassett, James M Wright
1Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada. morgan@chspr.ubc.ca
Plos Medicine
|April 21, 2005
Summary
First-line hypertension treatment for seniors often deviates from evidence-based guidelines. Thiazide diuretics, recommended for effectiveness and cost, were underutilized, especially in patients with comorbidities, indicating significant health and financial costs.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Thiazide diuretics are recommended as first-line treatment for hypertension due to proven cardiovascular benefits and cost-effectiveness.
- Hypertension management in seniors requires careful consideration of comorbidities and evidence-based prescribing.
Purpose of the Study:
- To assess the proportion of senior patients receiving thiazide diuretics as first-line hypertension therapy.
- To investigate whether cardiovascular and other comorbidities influence the choice of initial hypertension treatment.
Main Methods:
- Utilized British Columbia PharmaCare data (1993-2000) to identify seniors initiating hypertension drug therapy.
- Linked prescription data with health claims to analyze first-line treatment choices in relation to patient demographics and comorbidities.
Main Results:
- 82,824 seniors were included; first-line thiazide use varied significantly (38% without comorbidity to 9% with prior myocardial infarction).
- First-line thiazide prescribing increased over the study period, with higher rates in women and older patients.
- Comorbidities, particularly acute myocardial infarction, were associated with lower thiazide prescribing rates.
Conclusions:
- First-line hypertension prescribing practices in seniors are not fully aligned with evidence from clinical trials.
- Suboptimal selection of effective and cost-efficient therapies incurs substantial health and financial burdens.
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