Changes in the pharmacologic treatment of hypertension in the department of veterans affairs 1997-1999: Decreased use of calcium antagonists and increased use of beta-blockers and thiazide diuretics

Older studies of antihypertensive treatment have shown that prescribing pat terns are not consistent with recommendations from expert national panels. We determined whether prescribing patterns for antihypertensive drugs chang ed recently in the largest integrated health care system in the United Stat es. Specifically, we determine 1) patterns of antihypertensive medication u se at all Department of Veterans Affairs (VA) medical facilities for fiscal years 1997 to 1999, 2) the cost of this care, and 3) savings associated wi th changes in treatment patterns. Data were aggregated by individual medica tion as well as by antihypertensive drug class. Estimates of VA national an tihypertensive drug costs are based on the median cost and the number of un its for each dosage form of each medication dispensed at all facilities. At VA medical facilities, calcium antagonist use went from 33% to 29.3% of antihypertensive treatment days between 1997 and 1999, angiotensin converti ng enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) use from 36.4% to 36.8%, beta -blockers from 19.1% to 21.1%, and thiazide diuretic use fr om at 11.5% to 12.8%. If treatment patterns had remained the same between 1 997 and 1999 in terms of the proportion of medications from each drug class , an additional six million dollars would have been spent on antihypertensi ve medications in 1999. Although calcium antagonists and ACE inhibitors/ARB remained the most commo nly dispensed antihypertensives at VA facilities from 1997 to 1999, there w as a proportional decrease in calcium antagonist use and an increase in the use of thiazide diuretics and beta -blockers. These changes were consisten t with improved compliance with VA national guidelines. The cost implicatio ns of these changes in practice patterns were considerable. Am J Hypertens 2001; 14:957-962 (C) 2001 American Journal of Hypertension, Ltd.