title: The impact of thiazide diuretics on the initiation of lipid-reducing agents in older people: a population-based analysis.
abstract: OBJECTIVE
  The objective of this study was to examine how often treatment for hyperlipidemia followed the use of thiazides, compared with the use of other antihypertensive drugs, in older patients.
  
  
  METHODS
  Retrospective follow-up of all health claims filed over a 12-month period.
  
  
  METHODS
  New Jersey Medicaid and Medicare programs.
  
  
  METHODS
  A total of 9274 enrollees, aged 65 to 99, who were newly initiated on antihypertensive medications from 1981-1989.
  
  
  METHODS
  We measured rates of lipid-reducing agent (LRA) initiation among patients in the 2 years following antihypertensive initiation (thiazide, non-thiazide drug, or combinations of the two) compared with rates among patients not currently taking antihypertensive agents. We used Cox regression analyses to estimate relative risks (RR), accounting for switching in antihypertensive therapy and for time when drug therapy was not currently available according to pharmacy refill records.
  
  
  RESULTS
  There were 226 patients (2.4%) in the cohort who were started on LRA during the follow-up period. After adjusting for potential confounders, we found no significant relationship between LRA initiation and overall thiazide use (RR 1.47, 95% CI 0.89-2.40), or other antihypertensive use, relative to no current exposure. However, use of high-dose thiazides (> or = 50 mg) was associated significantly with LRA initiation (RR 1.97, 95% CI 1.12-3.45). Factors associated with decreased incidence of LRA use included age > or = 85 (RR 0.59, 95% CI 0.36-0.96), black race (RR 0.58, 95% CI 0.37-0.91), and nursing home residency (RR 0.20, 95% CI 0.11-0.35).
  
  
  CONCLUSIONS
  Use of low-cost and effective thiazide diuretics in older hypertensives was not associated with more common initiation of lipid-reducing agents, except with high-dose use of thiazides currently seen as inappropriate in most cases. Age and race were important determinants of LRA use.
authors.affiliation: Gerontology Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: M
authors.initials: M
authors.lastname: Monane
authors.forename: J H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: R L
authors.initials: RL
authors.lastname: Bohn
authors.forename: R J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: R
authors.initials: R
authors.lastname: Levin
authors.forename: J
authors.initials: J
authors.lastname: Monette
authors.forename: J
authors.initials: J
authors.lastname: Avorn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001581:Benzothiadiazines; D004232:Diuretics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011159:Population Surveillance; D012189:Retrospective Studies; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects*
chemical_list: D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D000960:Hypolipidemic Agents; D049993:Sodium Chloride Symporter Inhibitors