TRENDS IN MEDICATION CHOICES FOR HYPERTENSION IN THE ELDERLY - THE DECLINE OF THE THIAZIDES

We studied the evolution in choice of antihypertensive therapy in the elderly over a seven-year period and defined factors associated with s uch prescribing. To accomplish this, we performed a retrospective anal ysis of 8428 enrollees older than 65 years of age in the New Jersey Me dicaid and Medicare programs newly begun on antihypertensive therapy b etween 1982 and 1988. Diuretics were the most common agents prescribed (51%), followed by calcium channel blockers (14%), beta-blockers (13% ), central adrenergic antagonists (11%), and angiotensin-converting en zyme inhibitors (5%). However, the use of diuretics declined sharply d uring the latter part of the time interval studied. Using logistic reg ression modeling, we determined that the odds of a subject being start ed on a diuretic compared with any other antihypertensive drug decreas ed from 1.0 during the referent years 1982 to 1984 to 0.75 in 1985 to 1986 and to 0.41 in 1987 to 1988, after controlling for demographics, comorbidity, and hospital and physician visits (P<.001). The relative odds of diuretic use were significantly increased (P<.05) for the olde st subjects (odds ratio, 1.28 for age 85 and older versus ages 65 to 7 4 odds), women (odds ratio, 1.15), and blacks (odds ratio, 1.14). Desp ite the growing evidence during the study interval of the efficacy of diuretics in treating hypertension in the elderly, diuretic use dimini shed throughout this period in relation to other antihypertensive drug s. Subject characteristics (oldest subjects, women, and blacks) were i mportant determinants of physicians' choice of antihypertensive therap y.