title: Prescribing patterns of diuretics in multi-drug antihypertensive regimens.
abstract: Recent literature suggests that most hypertensives will require two or more drugs to achieve target blood pressure. Our objective was to estimate the proportion of patients receiving diuretics, including thiazides, for blood pressure control among those receiving two or more drugs. We studied 25,052 hypertensives in a tertiary care Veterans Affairs facility and identified individuals taking any thiazide or loop diuretic among patients receiving two, three, four, or more drugs. Rates of any diuretic use were 50%, 73%, and 89%, and decreased to 39.0%, 59.0%, and 72.5% for thiazide use, respectively. Rates of thiazide use were statistically significantly higher among African Americans compared with the general study population, but did not differ significantly in the elderly. Though overall diuretic use seems to be increasing as compared with previous studies, there is room for improvement in the use of thiazides in multi-drug hypertension regimens.
authors.affiliation: VA Medical Center (111PC), 2002 Holcombe Boulevard, Houston, TX 77030, USA. hardeeps@bcm.tmc.edu
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000145:classification / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics
references.citation: J Clin Hypertens (Greenwich). 1999 Oct;1(2):106-114
references.pmid: 11416601
references.citation: Lancet. 1998 Jun 13;351(9118):1755-62
references.pmid: 9635947
references.citation: JAMA. 1993 Aug 11;270(6):713-24
references.pmid: 8336373
references.citation: Clin Ther. 2002 Sep;24(9):1451-62
references.pmid: 12380636
references.citation: Am J Hypertens. 2001 Sep;14(9 Pt 1):957-62
references.pmid: 11587164
references.citation: N Engl J Med. 1993 Apr 1;328(13):914-21
references.pmid: 8446138
references.citation: Arch Intern Med. 2003 Dec 8-22;163(22):2705-11
references.pmid: 14662624
references.citation: Arch Intern Med. 1995 Apr 24;155(8):829-37
references.pmid: 7717791
references.citation: Arch Intern Med. 2002 Nov 11;162(20):2325-32
references.pmid: 12418946
references.citation: JAMA. 1997 Dec 3;278(21):1745-8
references.pmid: 9388150
references.citation: Value Health. 2003 Jan-Feb;6(1):18-28
references.pmid: 12535235
references.citation: J Clin Hypertens (Greenwich). 2000 May;2(3):172-180
references.pmid: 11416643
references.citation: Arch Intern Med. 1997 Nov 24;157(21):2413-46
references.pmid: 9385294
references.citation: Am J Cardiol. 1988 Jan 1;61(1):117-21
references.pmid: 3276117
references.citation: Am J Hypertens. 1999 Apr;12(4 Pt 1):333-40
references.pmid: 10232492
references.citation: J Gen Intern Med. 2000 Oct;15(10):702-9
references.pmid: 11089713
references.citation: Ann Pharmacother. 2002 Oct;36(10):1505-11
references.pmid: 12243597
references.citation: Ann Intern Med. 2001 Nov 6;135(9):825-34
references.pmid: 11694107
references.citation: J Clin Hypertens (Greenwich). 2001 Nov-Dec;3(6):346-53
references.pmid: 11723356
references.citation: N Engl J Med. 1992 Aug 20;327(8):543-7
references.pmid: 1635569
references.citation: Am J Manag Care. 2004 Dec;10(12):926-32
references.pmid: 15617368
references.citation: N Engl J Med. 1998 Dec 31;339(27):1957-63
references.pmid: 9869666
references.citation: Arch Intern Med. 2002 Feb 25;162(4):413-20
references.pmid: 11863473
references.citation: JAMA. 1991 Jun 26;265(24):3255-64
references.pmid: 2046107
references.citation: JAMA. 2002 Dec 18;288(23):2981-97
references.pmid: 12479763
references.citation: Am J Hypertens. 1996 Apr;9(4 Pt 1):342-60
references.pmid: 8722437
references.citation: Arch Intern Med. 1999 Dec 13-27;159(22):2673-7
references.pmid: 10597757
references.citation: J Clin Hypertens (Greenwich). 2003 Mar-Apr;5(2):107-12
references.pmid: 12671322
references.citation: JAMA. 2003 May 21;289(19):2560-72
references.pmid: 12748199
references.citation: JAMA. 1998 Jun 10;279(22):1813-6
references.pmid: 9628713
references.citation: Am J Manag Care. 2004 Feb;10(2 Pt 2):163-70
references.pmid: 15005509
references.citation: Drugs. 2000;59 Suppl 2:21-25; discussion 39-40
references.pmid: 10678594
references.citation: Am J Hypertens. 2003 Nov;16(11 Pt 2):36S-40S
references.pmid: 14625159
references.citation: Am J Med. 1996 Sep 30;101(3A):53S-60S
references.pmid: 8876475
references.citation: Adv Data. 2003 Aug 11;(337):1-44
references.pmid: 12924075