Antihypertensive medication prescribing in 27,822 elderly Canadians with diabetes over the past decade.
OBJECTIVE
The purpose of this study was to examine whether prescribing practices for elderly individuals with diabetes and hypertension changed over the past decade.


METHODS
We linked the Ontario Diabetes Database and four administrative databases in Ontario, Canada, to identify 27,822 patients >65 years of age who had diabetes and were newly treated for hypertension between 1 January 1995 and 31 December 2001. All patients were followed for 2 years after their initial antihypertensive medication prescription.


RESULTS
The 27,822 patients in this study (mean age 72 years, 51% men) were treated with oral hypoglycemic agents alone (n = 17,128 patients, 62%), insulin alone (n = 2,346, 8%), both oral hypoglycemic agents and insulin (n = 2,205, 8%), or diet alone (n = 6,143, 22%). Management within the first 2 years of hypertension diagnosis consisted of antihypertensive monotherapy in 20,183 patients (73%), two antihypertensive drugs in 6,207 (22%), and three or more drugs in 1,432 (5%); the most frequently chosen antihypertensive drugs were ACE inhibitors (68%), thiazides (15%), and calcium channel blockers (9%). Between 1995 and 2001, physician prescribing practices changed: the population-adjusted rates of antihypertensive drug prescribing increased by 46% (95% CI 33-55%), the proportion of initial antihypertensive prescriptions for ACE inhibitors increased from 54 to 76% (P < 0.0001), and the use of multiple antihypertensive agents within the first 2 years of diagnosis increased from 21 to 32% (P < 0.0001).


CONCLUSIONS
Antihypertensive prescribing patterns in elderly individuals with diabetes changed over the past decade in Ontario in directions consistent with the evolving evidence base.
Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R7, Canada. finlay.mcalister@ualberta.ca
Finlay A
FA
McAlister
Norman R C
NR
Campbell
Minh
M
Duong-Hua
Zhongliang
Z
Chen
Karen
K
Tu
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002170:Canada; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents