Temporal patterns of antihypertensive medication use among elderly patients. The Cardiovascular Health Study
B. M. Psaty, P. J. Savage, G. S. Tell, J. F. Polak, C. H. Hirsch, J. M. Gardin and R. H. McDonald Jr
Department of Medicine, University of Washington, Seattle.
OBJECTIVES--To estimate the incidence of newly treated hypertension and to
describe the patterns of antihypertensive medication use among those aged
65 years and older. DESIGN--Medicare eligibility lists from four US
communities (Forsyth County, North Carolina; Washington County, Maryland;
Sacramento County, California; and Pittsburgh, Pa) were used to obtain a
representative sample of 5201 community-dwelling elderly for the
Cardiovascular Health Study, a prospective cohort study of risk factors for
coronary heart disease and stroke. Participants were examined at baseline
and again 1 year later. The two examinations included standardized
questionnaires, blood pressure measurements, and the assessment of
medication use by medication inventory. In this cohort analysis, we
excluded 231 subjects (4.4%) who did not return for follow-up, 69 (1.3%)
who had missing data for medications, and another 495 (9.5%) who were
taking "antihypertensive" medications for an indication other than high
blood pressure. INTERVENTIONS--None. RESULTS--Among the 4406 participants,
1613 used antihypertensive medications at both visits. Between the two
visits, 144 started and 115 stopped antihypertensive therapy. Among
nonusers at baseline, the annual incidence of newly treated hypertension
was 5.2% in women and 5.6% in men. Due to the number of participants who
stopped therapy, the overall prevalence of antihypertensive treatment
increased only slightly, from 40.7% to 41.1% in women and from 37.1% to
38.2% in men, during 1 year of follow-up. After adjustment for age,
systolic blood pressure, number of antihypertensive drugs, diabetes, and
cardiovascular disease, the newly treated hypertensives were about half as
likely as the previously treated hypertensives to receive diuretics (odds
ratio [OR], 0.59; P = .008) or beta-blockers (OR, 0.52; P = .01); and they
were about twice as likely to receive calcium channel blockers (OR, 1.88; P
< .004) or angiotensin converting enzyme inhibitors (OR, 2.40; P <
.001). A similar pattern of within-person changes over time was apparent
among the continuous users. CONCLUSIONS--Between June 1990 and June 1991,
physicians were increasingly prescribing angiotensin converting enzyme
inhibitors and calcium channel blockers in place of diuretics and
beta-blockers for the treatment of hypertension in elderly patients,
especially for those just starting therapy.
Large Increases in Hypertension Diagnosis and Treatment in Canada After a Healthcare Professional Education Program
Onysko et al.
Hypertension 2006;48:853-860.
ABSTRACT
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A Collaborative Initiative to Improve the Care of Elderly Medicare Patients With Hypertension
Meehan et al.
American Journal of Medical Quality 2004;19:103-111.
ABSTRACT
Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults: The Cardiovascular Health Study
Psaty et al.
Arch Intern Med 2002;162:2325-2332.
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Age-Related Bias in the Management of Hypertension: A National Survey of Physicians' Opinions on Hypertension in Elderly Adults
Hajjar et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:M487-491.
ABSTRACT
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Antihypertensive Drug Therapy in Saskatchewan: Patterns of Use and Determinants in Hypertension
Bourgault et al.
Arch Intern Med 2001;161:1873-1879.
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Recent advances: Geriatric
BMJ 2001;322:86-89.
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Trends in Antihypertensive Drug Advertising, 1985–1996
Wang et al.
Circulation 1999;99:2055-2057.
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Prevalence, Clinical Correlates, and Treatment of Hypertension in Elderly Nursing Home Residents
Gambassi et al.
Arch Intern Med 1998;158:2377-2385.
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Prospective Study of Calcium Channel Blocker Use, Cardiovascular Disease, and Total Mortality Among Hypertensive Women : The Nurses' Health Study
Michels et al.
Circulation 1998;97:1540-1548.
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Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population
Jones et al.
BMJ 1995;311:293-295.
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Trends in Medication Choices for Hypertension in the Elderly : The Decline of the Thiazides
Monane et al.
Hypertension 1995;25:1045-1051.
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