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Thiazide Diuretic Utilization Within the VA

Kiana Green1, Augustus Hough1

  • 1West Palm Beach Veterans Affairs Healthcare System, Florida.

Federal Practitioner : for the Health Care Professionals of the VA, Dod, and PHS
|May 30, 2024
PubMed

Insights

Hydrochlorothiazide (HCTZ) remains the most prescribed thiazide diuretic in the VA despite guidelines recommending chlorthalidone. Prescribing of chlorthalidone has significantly increased from 2016 to 2021.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • The 2017 ACC/AHA hypertension guideline designates chlorthalidone as the preferred thiazide diuretic.
  • Understanding current thiazide prescribing patterns within the US Department of Veterans Affairs (VA) is crucial for guideline adherence.

Purpose of the Study:

  • To analyze thiazide diuretic prescribing trends within the VA from 2016 to 2022.
  • To compare utilization rates, blood pressure control, and supplementation patterns among hydrochlorothiazide (HCTZ), chlorthalidone, and indapamide.

Main Methods:

  • Retrospective analysis of 628,994 active thiazide prescriptions (HCTZ, chlorthalidone, indapamide) from January 2016 to January 2022.
  • Statistical analysis (chi-squared test with Bonferroni correction) to determine utilization rates and compare outcomes.
  • Evaluation of concomitant potassium/magnesium supplementation and blood pressure control rates.

Main Results:

  • Hydrochlorothiazide (HCTZ) was the most utilized thiazide (84.6%), followed by chlorthalidone (14.9%) and indapamide (0.5%).
  • HCTZ use decreased from 90.2% to 83.5%, while chlorthalidone use increased from 9.3% to 16.0% (P < .001 for both trends).
  • No significant difference in blood pressure control rates was observed between thiazide groups (P = .58), but supplementation rates varied significantly (P < .001).

Conclusions:

  • Hydrochlorothiazide (HCTZ) remains the predominant thiazide diuretic prescribed in the VA, despite guidelines favoring chlorthalidone.
  • A significant upward trend in chlorthalidone prescribing was observed between 2016 and 2021.
  • These findings highlight the need for strategies to promote guideline-recommended chlorthalidone therapy.
Abstract

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