2016. Potential for Applying ALLHAT Study Results to High-Risk Older Veterans
Anjan Bhattacharyya, MD, University of Iowa and Iowa City VAMC, AB Hoth, University of Iowa and Iowa City VAMC, B Carter,
University of Iowa and Iowa City VAMC, EA Chrischilles,
University of Iowa and Iowa City VAMC, RI Shorr,
University of Tennessee, J Ness,
University of Iowa and Iowa City VAMC, GE Rosenthal,
University of Iowa and Iowa City VAMC, PJ Kaboli,
University of Iowa and Iowa City VAMC
Objectives: Evaluate current thiazide use and potential for switching from alternative anti-hypertensive agents in elderly veterans with hypertension.
Methods: The sample included 257 randomly selected primary care patients (mean age, 74 years; 97% male) enrolled in the Enhanced Pharmacy Outpatient Clinic (EPOC) Study. To be eligible for EPOC, patients were > 65 years and receiving prescriptions for > 5 medications (30% of primary care patients at the study site). Patients underwent a detailed clinical and medication history and medical record review by a clinical pharmacist. If appropriate for a switch to thiazides, potential savings in medication costs were determined based on VA pharmacy costs.
Results: 207 (81%) of the sample had hypertension, of whom 63 (30%) were already on thiazides. We further excluded 101 patients with CHF (per ALLHAT criteria), relative contraindications to thiazides, or in whom non-thiazide antihypertensive agents were clinically indicated. Thus, 43 patients (21% of hypertensive patients) were eligible for substituting thiazides in place of calcium-channel blockers (CCB), ACE-inhibitors, or alpha-blockers. The cost savings of making such changes were estimated to be $125 annually per patient switched. 94% of the cost savings resulted from replacing CCBs.
Conclusions: In a high risk elderly population, 1 in 5 hypertensive patients could be switched to thiazides from more costly, and possibly less efficacious, antihypertensive medications. Such changes would yield moderate savings to VHA.
Impact: These data may inform VA policy regarding the potential financial benefits of using thiazides preferentially for the treatment of hypertension.