A review of the prescribing trend of thiazide-type and thiazide-like diuretics in hypertension: A UK perspective

Abstract

Thiazide diuretics have been the cornerstone of hypertension treatment for >5 decades. Most recent European and American guidelines recommend both thiazide-type and thiazide-like diuretics as first-line drugs for all patients with hypertension. In contrast, diuretics are not regarded as first-line treatment in the UK and in patients who are to be initiated on a diuretic treatment, thiazide-like molecules, such as chlortalidone and indapamide are the preferred option. This review examines the prescribing trend of the 4 most commonly prescribed thiazide diuretics for the treatment of hypertension in the UK. Prescription cost analysis data were obtained for both 2010 and 2016/2017 for each region of the UK to analyse the impact of the 2011 National Institute for Health and Care Excellence hypertension guidelines on the trend in thiazide diuretic prescribing. Overall, the prescriptions of thiazide diuretics declined over the years. Bendroflumethiazide is the most commonly prescribed diuretic in the UK and despite some geographical differences, thiazide-type diuretics are more widely used than thiazide-like. The use of indapamide increased significantly between 2010 and 2016/2017 while chlortalidone was rarely employed. Of the many factors affecting trends in prescriptions, clinical inertia, treatment adherence, availability of the products and the lack of fixed dose combinations may play a role.

Keywords: diuretic; hypertension; prescribing; thiazide.

Figure 1

Charts representing the relative use of indapamide (INDA), hydrochlorothiazide (HCTZ), bendroflumethiazide (BDTZ) and chlortalidone (CTLD) in the UK (divided by region) in the years 2010 and 2016/2017. Data are expressed as percentage

Figure 2

Bar chart representing the total prescribed quantity of indapamide, hydrochlorothiazide, bendroflumethiazide and chlortalidone in each region of the UK. Data from 2010 (all regions) and 2017 for Northern Ireland, England and Wales and 2016 for Scotland are listed