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Diuretics underutilized in hypertensive black patients

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Treatment guidelines indicating that black patients with hypertension should be prescribed a diuretic drug were not adhered to more than half of the time, according to study results.

Researchers investigated 658 black patients aged 21 to 80 years with uncontrolled hypertension and found that only 46% were prescribed a diuretic.

Participants not prescribed a diuretic took fewer antihypertensive medications (1.7 vs. 2.9; P<.0001), had higher mean diastolic BP (89.2 mm Hg vs. 85.5 mm Hg; P=.0005) and were more likely to have systolic BP ≥160 mm Hg (57.6% vs. 49%; P=.04). When hypertensive patients were prescribed BP medication that included a diuretic, BP decreased (mean systolic BP decreased 5 mm Hg and mean diastolic BP decreased 4 mm Hg).

“Fewer than half of patients who were prescribed one or two drugs were prescribed a diuretic, indicating that the diuretics are not being chosen as the first or second line of treatment for the majority of patients,” Linda M. Gerber, PhD, of the department of public health at Weill Cornell Medical College, and colleagues wrote in the study.

Also, 21.5% of those who were prescribed at least three drugs were not taking a diuretic.

“The finding is even more disturbing, given the socioeconomic status of most patients in this study and the low cost of diuretic therapy that could enhance patient adherence,” they wrote.

In addition, not prescribing a diuretic to this patient population is contrary to the recommendation by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).

“Yet, we find that physicians are not using the drugs as they should in a population that is especially hard hit by high blood pressure and who suffer greater prevalence, severity, organ damage and mortality from the disease compared to other groups,” Gerber said in a press release.

For more information:

Gerber LM. Am J Hypertens. 2013;26:174-179.

Disclosure:Gerber reports receiving a grant from the NHLBI.