TEMPORAL PATTERNS OF ANTIHYPERTENSIVE MEDICATION USE AMONG OLDER ADULTS, 1989 THROUGH 1992 - AN EFFECT OF THE MAJOR CLINICAL-TRIALS ON CLINICAL-PRACTICE
Bm. Psaty et al., TEMPORAL PATTERNS OF ANTIHYPERTENSIVE MEDICATION USE AMONG OLDER ADULTS, 1989 THROUGH 1992 - AN EFFECT OF THE MAJOR CLINICAL-TRIALS ON CLINICAL-PRACTICE, JAMA, the journal of the American Medical Association, 273(18), 1995, pp. 1436-1438
Objective.-To describe the changing patterns of antihypertensive medic
ation use in the years immediately before and after the publication of
the results of three major clinical trials of the treatment of hypert
ension in older adults. Design.-In this cohort study, adults 65 years
or older were examined annually on four occasions between June 1989 an
d May 1992, and the use of antihypertensive medications was assessed b
y inventory at each visit. The four visits defined the boundaries of t
hree study periods. For each study period, participants receiving anti
hypertensive therapy were either continuous users (n = 1667, 1643, and
1605, respectively) or starters (n = 157, 142, 120) of hypertensive t
herapy. The large clinical trials that convincingly proved the efficac
y and safety of low-dose diuretic therapy in older adults were publish
ed during the latter parts of period 2 and the early parts of period 3
. Results.-Among starters, the proportion initiating therapy on diuret
ics increased from 35.9% in period 2 to 47.5% in period 3, significant
ly so among women (P=.04). The proportions initiating other drugs disp
layed no significant trends. Among continuous users, the use of diuret
ics, beta-blockers, and vasodilators generally decreased over the 3-ye
ar period, while the use of calcium channel blockers and angiotensin-c
onverting enzyme inhibitors increased significantly in each of the thr
ee periods (P<.05). The decline of 2.7% in the prevalence of diuretic
use in period 1 abated during period 2 (1.8% decline), and it slowed s
ignificantly (P=.03) to almost a complete halt during period 3 (0.2% d
ecline). The rate of increase in the use of calcium channel blockers s
lowed significantly (P=.01) between period 1 (+6.7%) and period 3 (+2.
8%). Conclusions.-Although other factors such as cost may have been im
portant, the temporal trends in antihypertensive drug therapy coincide
d in time with and may have reflected in part the influence of the maj
or clinical trials on the patterns of clinical practice.