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Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention

Tara I Chang1, Gregory Evans2, Alfred K Cheung2

  • 1From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.). tichang@stanford.edu.

Hypertension (Dallas, Tex. : 1979)
|February 12, 2016
PubMed

Insights

Thiazide diuretics are a common first-line hypertension treatment. This study found thiazide prescription varied by patient demographics and kidney function, highlighting a need for updated clinical practice guidelines.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Thiazides and thiazide-type diuretics are recommended as first-line antihypertensives.
  • Contemporary data on their real-world prescription patterns are limited.

Purpose of the Study:

  • To examine patterns and correlates of thiazide prescription in hypertensive patients with heightened cardiovascular risk.
  • To identify demographic and clinical factors associated with thiazide use.

Main Methods:

  • Cross-sectional analysis of baseline data from 7582 participants in the Systolic Blood Pressure Intervention Trial (SPRINT).
  • Log-binomial regression was used to calculate adjusted prevalence ratios for thiazide prescription.

Main Results:

  • Forty-three percent of participants received a thiazide at baseline; only 16% received it as monotherapy.
  • Thiazide prescription prevalence differed significantly by demographics: younger patients, women, and Black individuals were more likely to receive thiazides.
  • Patients with estimated glomerular filtration rate <30 mL/min/1.73 m2 were half as likely to be prescribed a thiazide compared to those with preserved kidney function.

Conclusions:

  • Thiazide prescription patterns in hypertensive patients with heightened cardiovascular risk vary significantly based on demographic factors and kidney disease status.
  • These variations exist despite limited evidence on differential effectiveness across subgroups.

Keywords:
antihypertensive agentsblood pressurehypertensionrisk factorsthiazides

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