Trends in medication choices for hypertension in the elderly. The decline of the thiazides.
Trends in medication choices for hypertension in the elderly. The decline of the thiazides.
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老年人高血压药物选择的趋势。
DOI：
10.1161/01.hyp.25.5.1045
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Avorn,J
中科院分区：
文献类型：
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作者：
Monane,M;Glynn,RJ;Gurwitz,JH;Bohn,RL;Levin,R;Avorn,J
我们研究了7年来老年人抗高血压治疗选择的演变，并确定了与此类处方相关的因素。为了实现这一点，我们对1982年至1988年期间新开始接受抗高血压治疗的新泽西医疗补助和医疗保险计划中年龄大于65岁的8428名登记者进行了回顾性分析。利尿剂是最常见的处方药物（51%），其次是钙通道阻滞剂（14%）、β受体阻滞剂（13%）、中枢肾上腺素能拮抗剂（11%）和血管紧张素转换酶抑制剂（5%）。然而，在研究的时间间隔的后期，利尿剂的使用急剧下降。使用逻辑回归模型，我们确定，在控制了人口统计学、合并症、医院和医生的访问（P<.001）。年龄最大的受试者（85岁及以上与65 - 74岁的比值比为1.28）、女性（比值比为1.15）和黑人（比值比为1.14）使用利尿剂的相对比值显著增加（P<0.05）。尽管在研究期间越来越多的证据表明利尿剂治疗老年人高血压的疗效，但与其他抗高血压药物相比，利尿剂的使用在整个研究期间减少。受试者特征（年龄最大的受试者、女性和黑人）是医生选择抗高血压治疗的重要决定因素。
We studied the evolution in choice of antihypertensive therapy in the elderly over a seven-year period and defined factors associated with such prescribing. To accomplish this, we performed a retrospective analysis of 8428 enrollees older than 65 years of age in the New Jersey Medicaid and Medicare programs newly begun on antihypertensive therapy between 1982 and 1988. Diuretics were the most common agents prescribed (51%), followed by calcium channel blockers (14%), β-blockers (13%), central adrenergic antagonists (11%), and angiotensin-converting enzyme inhibitors (5%). However, the use of diuretics declined sharply during the latter part of the time interval studied. Using logistic regression modeling, we determined that the odds of a subject being started on a diuretic compared with any other antihypertensive drug decreased from 1.0 during the referent years 1982 to 1984 to 0.75 in 1985 to 1986 and to 0.41 in 1987 to 1988, after controlling for demographics, comorbidity, and hospital and physician visits (P<.001). The relative odds of diuretic use were significantly increased (P<.05) for the oldest subjects (odds ratio, 1.28 for age 85 and older versus ages 65 to 74 odds), women (odds ratio, 1.15), and blacks (odds ratio, 1.14). Despite the growing evidence during the study interval of the efficacy of diuretics in treating hypertension in the elderly, diuretic use diminished throughout this period in relation to other antihypertensive drugs. Subject characteristics (oldest subjects, women, and blacks) were important determinants of physicians’ choice of antihypertensive therapy.