THE IMPACT OF THIAZIDE DIURETICS ON THE INITIATION OF LIPID-REDUCING AGENTS IN OLDER-PEOPLE - A POPULATION-BASED ANALYSIS

OBJECTIVE: The objective of this study was to examine how often treatm ent for hyperlipidemia followed the use of thiazides, compared with th e use of other antihypertensive drugs, in older patients. DESIGN: Retr ospective follow-up of all health claims filed over a 12-month period. SETTING: New Jersey Medicaid and Medicare programs. PARTICIPANTS: A t otal of 9274 enrollees, aged 65 to 99, who were newly initiated on ant ihypertensive medications from 1981-1989. MEASUREMENTS: We measured ra tes of lipid-reducing agent (LRA) initiation among patients in the 2 y ears following antihypertensive initiation (thiazide, non-thiazide dru g, or combinations of the two) compared with rates among patients not currently taking antihypertensive agents. We used Cox regression analy ses to estimate relative risks (RR), accounting for switching in antih ypertensive therapy and for time when drug therapy was not currently a vailable according to pharmacy refill records. RESULTS: There were 226 patients (2.4%) in the cohort who were started on LRA during the foll ow-up period. After adjusting for potential confounders, we found no s ignificant relationship between LRA initiation and overall thiazide us e (RR 1.47, 95% CI 0.89-2.40), or other antihypertensive use, relative to no current exposure. However, use of high-dose thiazides (greater than or equal to 50 mg) was associated significantly with LRA initiati on (RR 1.97, 95% CI 1.12-3.45). Factors associated with decreased inci dence of LRA use included age greater than or equal to 85 (RR 0.59, 95 % CI 0.36-0.96), black race (RR 0.58, 95% CI 0.37-0.91), and nursing h ome residency (RR 0.20, 95% CI 0.11-0.35). CONCLUSION: Use of low-cost and effective thiazide diuretics in older hypertensives was not assoc iated with more common initiation of lipid-reducing agents, except wit h high-dose use of thiazides currently seen as inappropriate in most c ases. Age and race were important determinants of LRA use.