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Antihypertensive Medication Prescribing in 27,822 Elderly Canadians With Diabetes Over the Past Decade

¹ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
² Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
³ Departments of Medicine and Pharmacology and Therapeutics, University of Calgary, Calgary, Alberta, Canada
⁴ University Health Network, Toronto Western Hospital Family Medicine Centre, Toronto, Ontario, Canada
⁵ Departments of Family and Community Medicine, Family Healthcare Research Unit, University of Toronto, Toronto, Ontario, Canada

Address correspondence and reprint requests to Finlay McAlister, 2E3.24 Walter Mackenzie Centre, University of Alberta Hospital, 8440 112 St., Edmonton, Alberta T6G 2R7, Canada. E-mail: finlay.mcalister{at}ualberta.ca

OBJECTIVE—The purpose of this study was to examine whether prescribing practices for elderly individuals with diabetes and hypertension changed over the past decade.

RESEARCH DESIGN AND METHODS—We linked the Ontario Diabetes Database and four administrative databases in Ontario, Canada, to identify 27,822 patients >65 years of age who had diabetes and were newly treated for hypertension between 1 January 1995 and 31 December 2001. All patients were followed for 2 years after their initial antihypertensive medication prescription.

RESULTS—The 27,822 patients in this study (mean age 72 years, 51% men) were treated with oral hypoglycemic agents alone (n = 17,128 patients, 62%), insulin alone (n = 2,346, 8%), both oral hypoglycemic agents and insulin (n = 2,205, 8%), or diet alone (n = 6,143, 22%). Management within the first 2 years of hypertension diagnosis consisted of antihypertensive monotherapy in 20,183 patients (73%), two antihypertensive drugs in 6,207 (22%), and three or more drugs in 1,432 (5%); the most frequently chosen antihypertensive drugs were ACE inhibitors (68%), thiazides (15%), and calcium channel blockers (9%). Between 1995 and 2001, physician prescribing practices changed: the population-adjusted rates of antihypertensive drug prescribing increased by 46% (95% CI 33–55%), the proportion of initial antihypertensive prescriptions for ACE inhibitors increased from 54 to 76% (P < 0.0001), and the use of multiple antihypertensive agents within the first 2 years of diagnosis increased from 21 to 32% (P < 0.0001).

CONCLUSIONS—Antihypertensive prescribing patterns in elderly individuals with diabetes changed over the past decade in Ontario in directions consistent with the evolving evidence base.

Abbreviations: MICRO-HOPE, Microalbuminuria, Cardiovascular, and Renal Outcomes-Heart Outcomes Prevention Evaluation • ODB, Ontario Drug Benefit

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