Thiazide diuretics may be used in first-line treatment of hypertension in nursing home residents

Long-term nursing home residents treated for hypertension are less likely to receive and more likely to discontinue treatment with a thiazide diuretic than any other first-line antihypertensive medication, a study reports. However, the drug does not carry an increased risk of incontinence or hospitalization and may thus be a reasonable first-line blood pressure (BP)-lowering treatment choice in this population.

The study involved 152,902 hypertensive individuals living long term in a nursing home in 2013. Of these, 52.2 percent were treated with β-blockers (22 percent as a single agent), 39.7 percent with calcium channel blockers (14 percent as a single agent), 38.8 percent with angiotensin-converting enzyme inhibitors (14 percent as a single agent), 14.2 percent with thiazide diuretics (2 percent as a single agent), and 13.2 percent with angiotensin II receptor blockers (ARBs; 4 percent as a single agent). Residents on nonthiazide diuretics were excluded.

More than half of the population (55.1 percent) were treated with a single BP-lowering drug, 33.2 percent with two drugs, and 11.8 percent with three or more drugs. From the second to fourth quarter of the year, thiazide diuretics were more frequently discontinued than any other class (19.4 percent vs 14.1–16.1 percent; p<0.05) and less likely initiated than any other class except ARBs (1.4 percent vs 3.8–5.3 percent for each of the other three drug classes).

Urinary incontinence occurred in 76.6 percent of the population. Multivariate logistic regression analysis revealed that new diuretics use from the second to fourth quarter of 2013 did not result in higher rates of urinary incontinence in Q4, and none of the antihypertensive drug classes were associated with 6-month hospitalization.