title: Time trends in the use of anti-hypertensive medications: results from the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Previous reports have suggested that new evidence of the comparative effectiveness of different medication classes from randomized controlled trials (RCTs) does not always alter treatment decisions for first-line anti-hypertensive therapy.
  
  
  OBJECTIVE
  To evaluate the association of RCT evidence in December 2002 from the Anti-hypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) on use of anti-hypertensive medications in a multi-ethnic cohort.
  
  
  METHODS
  The Multi-Ethnic Study of Atherosclerosis (MESA) study, a prospective cohort study of 6814 adults from four ethnic groups, had four separate assessments of drug use. Users of anti-hypertensive medications at baseline were excluded. We evaluated temporal changes in the medication class reported by new users of anti-hypertensive medications.
  
  
  RESULTS
  After the exclusion of anti-hypertensive drug users at baseline, 32% of new users of anti-hypertensive drugs seen at exam 2 were prescribed a diuretic. The publication of ALLHAT was associated with a subsequent increase in the proportion of new users taking diuretics at exam 3 compared with exam 2 (relative risk (RR): 1.31; 95% confidence interval (CI): 1.09-1.59). After the report from ALLHAT, the proportion of users of diuretics seen at exam 3 rose to 44% (starting in 2004) and 39% in exam 4 (starting in 2005). This increase in the proportion of diuretic use among new users of anti-hypertensive medications declined slightly but could still be detected at exam 4 as compared to exam 2 (RR: 1.28; 95%CI: 1.04-1.57).
  
  
  CONCLUSIONS
  The randomized trial evidence from the ALLHAT study was temporally associated with a moderate increase in diuretic use.
authors: Department of Biostatistics, University of Washington, Seattle, WA 98115, USA.
authors: Joseph A C
authors: JA
authors: Delaney
authors: Robyn L
authors: RL
authors: McClelland
authors: Curt D
authors: CD
authors: Furberg
authors: Richard
authors: R
authors: Cooper
authors: Steven
authors: S
authors: Shea
authors: Gregory
authors: G
authors: Burke
authors: Bruce M
authors: BM
authors: Psaty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy*; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States / Q000208:ethnology
chemical_list: D000959:Antihypertensive Agents