The publication of the ALLHAT trial was associated with an increase in the proportion of new anti-hypertensive users taking diuretics from 32% to 44% (RR 1.31; 95% CI 1.09-1.59).
Cohort (n=6,814)
Does the publication of the ALLHAT trial increase the prescription of diuretics among new users of anti-hypertensive medications?
The publication of the ALLHAT trial was temporally associated with a moderate increase in the prescription of diuretics for new users of anti-hypertensive medications.
Effect estimate: RR 1.31 (95% CI 1.09-1.59)
Absolute Event Rate: 44% vs 32%
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. OBJECTIVES: 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.
Delaney et al. (Tue,) conducted a cohort in Hypertension (n=6,814). Publication of ALLHAT trial evidence vs. Pre-publication period (Exam 2) was evaluated on Proportion of new users of anti-hypertensive medications prescribed a diuretic (RR 1.31, 95% CI 1.09-1.59). The publication of the ALLHAT trial was associated with an increase in the proportion of new anti-hypertensive users taking diuretics from 32% to 44% (RR 1.31; 95% CI 1.09-1.59).
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