Trends in antihypertensive drugs in the elderly: the decline of thiazides

The last decade has seen the publication of different editions of guideline s for the pharmacological treatment of hypertension that were based on the results of large, randomised trials. Since these guidelines were meant to i nform practitioners, we analysed the pattern of prescription of antihyperte nsive agents between 1988 and 1997 among older hospitalised adults, Because of the wealth of data supporting the use of thiazides diuretics, we focuse d on diuretic prescription, to identify independent predictors of their uti lisation. To this end, we used the GIFA database that includes patients adm itted to academic medical centres throughout Italy between 1988 and 1997, W e studied 5061 patients over 85 years of age selected among a population of 28 411, based on the diagnosis of arterial hypertension at discharge. The use of ACE-inhibitors has been raising steadily through the years, and they are the agents most commonly used since 1996, Calcium channel blockers sho wed a similar trend and were the top prescribing drug until 1995; afterward s, the documentation of potentially severe side effects has resulted in a n early 20% reduction of their use. Beta-blockers have remained unpopular thr oughout the decade. Instead, the prescription of diuretics as a class showe d a biphasic trend; an initial decrease with a prolonged steady state and a more recent raise, However, at a separate analysis, it was a evident that a progressive increase of the use of loop diuretics since 1988 has been par alleled by a nearly 50% reduction of thiazides prescriptions. Loop diuretic s were more likely to be prescribed to older individuals, those with cardia c heart failure, coronary heart disease and high creatinine level. In contr ast, independent predictors of thiazides use were female gender, good funct ional status, preserved renal function, and absence of cardiovascular comor bidity, In conclusion, despite continued recommendations to use thiazides d iuretics for the treatment of hypertension among older individuals, their u se has been declining steadily between 1988 and 1997, A possible explanatio n is that the choice to prescribe a thiazides diuretic is influenced by age , functional status and comorbidity.