Randomized Controlled Trial

. 2016 Mar;67(3):550-5.

doi: 10.1161/HYPERTENSIONAHA.115.06851. Epub 2016 Jan 25.

Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial

Tara I Chang¹, Gregory Evans², Alfred K Cheung², William C Cushman², Matthew J Diamond², Jamie P Dwyer², Yonghong Huan², Dalane Kitzman², John B Kostis², Suzanne Oparil², Anjay Rastogi², Christianne L Roumie², Rukmani Sahay², Randall S Stafford², Addison A Taylor², Jackson T Wright Jr², Glenn M Chertow²; SPRINT Study Research Group

Affiliations

¹ From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.). tichang@stanford.edu.
² From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.).

PMID: 26865200
PMCID: PMC4755350
DOI: 10.1161/HYPERTENSIONAHA.115.06851

Randomized Controlled Trial

Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial

Tara I Chang et al. Hypertension. 2016 Mar.

. 2016 Mar;67(3):550-5.

doi: 10.1161/HYPERTENSIONAHA.115.06851. Epub 2016 Jan 25.

Authors

Affiliations

¹ From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.). tichang@stanford.edu.
² From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.).

PMID: 26865200
PMCID: PMC4755350
DOI: 10.1161/HYPERTENSIONAHA.115.06851

Abstract

Thiazides and thiazide-type diuretics are recommended as first-line agents for the treatment of hypertension, but contemporary information on their use in clinical practice is lacking. We examined patterns and correlates of thiazide prescription in a cross-sectional analysis of baseline data from participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). We examined baseline prescription of thiazides in 7582 participants receiving at least 1 antihypertensive medication by subgroup, and used log-binomial regression to calculate adjusted prevalence ratios for thiazide prescription (versus no thiazide). Forty-three percent of all participants were prescribed a thiazide at baseline, but among participants prescribed a single agent, the proportion was only 16%. The prevalence of thiazide prescription differed significantly by demographic factors, with younger participants, women, and blacks all having higher adjusted prevalence of thiazide prescription than other corresponding subgroups. Participants in the lowest category of kidney function (estimated glomerular filtration rate <30 mL/min per 1.73 m2) were half as likely to be prescribed a thiazide as participants with preserved kidney function. In conclusion, among persons with hypertension and heightened cardiovascular risk, we found that thiazide prescription varied significantly by demographics and kidney disease status, despite limited evidence about relative differences in effectiveness.

Trial registration: ClinicalTrials.gov NCT01206062.

Keywords: antihypertensive agents; blood pressure; hypertension; risk factors; thiazides.

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Figures

**Figure 1**
Distribution of antihypertensive medication class prescription among SPRINT participants prescribed A) a single agent at baseline (N=2436); and B) two agents at baseline (N=2967). Abbreviations: ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin II receptor blocker; BB = beta-blocker; CCB = calcium channel blocker;

**Figure 2**
Adjusted prevalence ratios (PR) and 95% confidence intervals (CI) of thiazide prescription in SPRINT participants receiving at least 1 antihypertensive medication at baseline. Abbreviation: eGFR = estimated glomerular filtration rate

See this image and copyright information in PMC

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Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial

Affiliations

Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical