Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose

J Am Geriatr Soc. 1999 Aug;47(8):954-9. doi: 10.1111/j.1532-5415.1999.tb01290.x.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Adrenergic beta-Antagonists / chemistry
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Atenolol / administration & dosage
  • Chlorthalidone / administration & dosage
  • Confidence Intervals
  • Databases as Topic
  • Diuretics / administration & dosage
  • Drug Compounding
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Hydrochlorothiazide / administration & dosage
  • Logistic Models
  • Male
  • Metolazone / administration & dosage
  • Metoprolol / administration & dosage
  • Myocardial Infarction / drug therapy
  • Odds Ratio
  • Ontario
  • Propranolol / administration & dosage
  • Retrospective Studies
  • Sex Factors
  • Sodium Chloride Symporter Inhibitors / administration & dosage*
  • Sodium Chloride Symporter Inhibitors / adverse effects
  • Sodium Chloride Symporter Inhibitors / chemistry
  • Timolol / administration & dosage


  • Adrenergic beta-Antagonists
  • Diuretics
  • Sodium Chloride Symporter Inhibitors
  • Hydrochlorothiazide
  • Atenolol
  • Timolol
  • Propranolol
  • Metoprolol
  • Chlorthalidone
  • Metolazone