May 10, 1995JAMA
Temporal patterns of antihypertensive medication use among older adults, 1989 through 1992. An effect of the major clinical trials on clinical practice?
Key result
Following the publication of major clinical trials, the proportion of older adults initiating antihypertensive therapy with diuretics increased from 35.9% to 47.5%.
Why the study?
Does the publication of major clinical trials influence the temporal patterns of antihypertensive medication use in older adults?
Population
Adults 65 years or older receiving antihypertensive therapy, categorized as continuous users or starters.
Comparison
Antihypertensive therapy vs Temporal comparison across three study periods…
Design
Cohort
Follow-up
3 years (four annual visits between June 1989 and May 1992)
Authors
Discussion
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Implication
Trial publications coincided with increased diuretic initiation among older adults; leaves open causal effects on prescribing patterns.
Study Design
Type
Cohort
Structured PICO
Does the publication of major clinical trials influence the temporal patterns of antihypertensive medication use in older adults?
P
Population
Adults 65 years or older receiving antihypertensive therapy, categorized as continuous users (n=1667, 1643, and 1605 across three periods) or starters (n=157, 142, and 120 across three periods).
I
Intervention
Antihypertensive therapy (diuretics, beta-blockers, vasodilators, calcium channel blockers, angiotensin-converting enzyme inhibitors)
C
Comparator
Temporal comparison across three study periods (June 1989 to May 1992) before and after the publication of major clinical trials
O
Outcome
Proportion of patients initiating or continuing specific classes of antihypertensive medications
Main Result
Absolute Event Rate: 47.5% vs 35.9%
The publication of major clinical trials demonstrating the efficacy of low-dose diuretics in older adults coincided with a significant increase in diuretic initiation and a halt in the decline of their continuous use in clinical practice.
Limitations
- Other factors such as cost may have been important in influencing temporal trends
Cite This Study
Bruce M. Psaty (1995) conducted a cohort in Hypertension. Antihypertensive medications vs. Temporal trends (Period 1 vs Period 2 vs Period 3) was evaluated on Proportion initiating therapy on diuretics. Following the publication of major clinical trials, the proportion of older adults initiating antihypertensive therapy with diuretics increased from 35.9% to 47.5%.