title: Antihypertensive medicines utilization: A decade-long nationwide study of octogenarians, nonagenarians and centenarians.
abstract: OBJECTIVE
  Gaining an insight into the utilization of antihypertensive medicines against a background of evolving hypertension treatment guidelines that might not be relevant to the oldest old is important. The aim of the present study was to characterize the overall trends in the utilization of antihypertensive medicines in the oldest old by therapeutic class and chemical type, stratified by age and sex over a decade.
  
  
  METHODS
  Antihypertensive medicines utilization was examined using the therapeutic and chemical groups based on the World Health Organization Collaborating Center for Drug Statistics Mythology's Anatomical Therapeutic Chemical classification system for all individuals aged ≥80 years. Regression and repeated cross-sectional analyses was carried out, and defined daily dose was used to describe the utilization per thousand older people per day.
  
  
  RESULTS
  Utilization of antihypertensive medicines increased over the decade from 187.28 in 2005 to 205.01 defined daily dose per thousand older people per day in 2014, and shifted from mainly diuretics to angiotensin-converting enzyme inhibitors. Interestingly, with the exception of diuretics, utilization of all medicines decreased gradually with increasing age. Single products use increased by 1.48-fold in 2014 compared with 2005, and for fixed-dose combinations the increase was 1.41-fold for the same period.
  
  
  CONCLUSIONS
  The increased utilization of angiotensin-converting enzyme inhibitors is consistent with recommendations from cardiovascular guidelines formulated from large randomized control trials that often exclude the oldest old. Interestingly, the utilization of beta-blockers decreased and diuretics increased in centenarians. The utilization of calcium channel blockers and angiotensin-converting enzyme inhibitors across the study period increased in all age categories. Geriatr Gerontol Int 2017; 17: 1109-1117.
authors.affiliation: School of Pharmacy, University of Otago, Dunedin, New Zealand.
authors.forename: Sujita W
authors.initials: SW
authors.lastname: Narayan
authors.affiliation: School of Pharmacy, University of Otago, Dunedin, New Zealand.
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Nishtala
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000494:pharmacology; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D009520:New Zealand; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers
keywords: antihypertensives; cardiovascular; drug utilization; older people; preventive medicines