Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose.
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Adrenergic beta-Antagonists; Age Factors; Aged; Aged, 80 and over; Atenolol; Chlorthalidone; Confidence Intervals; Databases as Topic; Diuretics; Drug Compounding; Evaluation Studies as Topic; Female; Humans; Hydrochlorothiazide; Logistic Models; Male; Metolazone; Metoprolol; Myocardial Infarction; Odds Ratio; Ontario; Propranolol; Retrospective Studies; Sex Factors; Sodium Chloride Symporter Inhibitors; Timolol
Health Services Research | Medicine and Health Sciences
OBJECTIVES: Low-dose drug therapy is promoted as a way to maximize benefit and minimize adverse drug effects when prescribing for older adults. This population-based study evaluates the age and sex-related use of two common therapies: thiazide diuretics, where evidence supports the use of low-dose therapy, and beta-blockers, where trials have not evaluated the minimum effective dose. DESIGN: Using linked administrative databases we identified all of the 120,613 persons dispensed a thiazide diuretic therapy and 12,908 myocardial infarction survivors dispensed beta-blocker therapy in Canada's largest province. We used logistic regression models to study the association of age and sex with dispensing of low-dose thiazide diuretic and beta-blocker therapy at doses lower than evaluated in trials. RESULTS: Of 120,613 older people dispensed a thiazide diuretic, 32,372 (26.8%) were dispensed a low dose. Patients 85 years of age or older, relative to the youngest group, were 30% more likely to be dispensed low-dose therapy (OR=1.31; 95% CI, 1.27 to 1.36; P < .001). Women were 8% more likely than men to be dispensed a low-dose thiazide diuretic (OR=1.08; 95% CI, 1.05 to 1.11; P < .001). Of 10,991 myocardial infarction survivors dispensed atenolol, metoprolol, propranolol, or timolol, 9458 (86.1%) were dispensed a lower-than-evaluated dose. Patients 85 years of age or older, relative to those in the youngest group, were more than twice as likely to be dispensed a lower-than-evaluated beta-blocker therapy dose (OR=2.28; 95% CI, 1.74 to 3.04; P < .001). No difference was noted in the use of beta-blocker therapy dose by sex (OR=1.0; 95% CI, .89 to 1.15; P = .95). CONCLUSIONS: Low-dose thiazide diuretic therapy prescribed widely to older people, particularly those of advanced age and women. The vast majority of myocardial infarction survivors were dispensed beta-blocker therapy at lower-than-evaluated doses. These findings highlight the need to manufacture low-dose thiazide diuretic therapy and to evaluate the minimum effective dose of beta-blocker therapy.
J Am Geriatr Soc. 1999 Aug;47(8):954-9.
Journal of the American Geriatrics Society
Rochon, Paula A.; Anderson, Geoffrey M.; Tu, Jack V.; Gurwitz, Jerry H.; Clark, Jocalyn P.; Shear, Neil H.; and Lau, Paula, "Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose." (1999). Meyers Primary Care Institute Publications and Presentations. 102.