To the Editor.
—The study by Psaty et al1 raises several important issues. After adjusting for diabetes, coronary artery disease, urinary incontinence, and congestive heart failure, they found that newly diagnosed hypertensive patients were more likely to receive angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers than older drugs. While certainly not unexpected, the findings have significant cost implications both for the individual older person with hypertension, as well as for the health care system, which spent an estimated $3.3 billion just on antihypertensive drugs in 1993.2 More important, if the newer drugs are unaffordable to many older persons, will the recent gains in the percentage of persons with controlled hypertension be lost?The authors have indicated that the prescribing of diuretics in older populations should have increased after June 1991 based on the accumulating evidence from three studies,3-5 two of which were in British journals.
Hume AL. Diuretics and β-Blockers for Hypertension: Seeking Respect. JAMA. 1994;271(12):904. doi:10.1001/jama.1994.03510360028022