Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #119 

March 2006 

Diuretic Use in the Treatment of 

Hypertension, by Selected Population 

Characteristics, 2003 

Highlights 

 In 2003, females age 18 

and older who were 

reported as receiving 

treatment for hypertension 

were more likely (49.5 

percent) to use a diuretic

than males (40.2 percent). 

 More than half (52.6 

percent) of elderly adults

who were reported as

receiving treatment for 

hypertension used a 

diuretic in 2003. This was 

larger than the proportion

of adults ages 45 to 64 

(43.7 percent) and young 

adults ages 18 to 44 (26.7 

percent). 

 Among adults reported as

receiving treatment for 

hypertension in 2003, black 

non-Hispanics (53.2 

percent) were more likely 

to use a diuretic than white 

non-Hispanics (45.6 

percent), Hispanics (34.8 

percent). or other nonHispanics (33.0 percent). 

 In 2003, adults with less 

than a high school 

education who were 

reported as receiving 

treatment for hypertension 

were more likely (49.8 

percent) to use a diuretic

than those with a high 

school education (43.4 

percent) or those with 

some college education 

(44.6 percent). 

G. Edward Miller, PhD and Alok Doshi, MBA 

Introduction 

Hypertension is a chronic condition that is commonly treated with 

several classes of medications, including diuretics, beta blockers, 

calcium channel blockers, and ACE inhibitors. JNC 7 guidelines, 

which were issued in 2003, recommend that pharmacological 

treatment of uncomplicated hypertension should begin with diuretics; 

and, when more than one class of drugs is required to control blood 

pressure, treatment should usually include a diuretic.* 

This Statistical Brief presents nationally representative estimates 

based on data from the Household Component of the Medical 

Expenditure Panel Survey (MEPS-HC) on diuretic use in the U.S. 

civilian noninstitutionalized population in 2003. The sample is 

composed of adults ages 18 and older who were reported to have 

received treatment for hypertension during the year. Diuretic use is

examined in this population overall and in subgroups of this 

population defined by age, sex, race/ethnicity, income, insurance 

status, education, and health status. All differences discussed in the 

text are statistically significant at the 0.05 level or better. 

Findings

In 2003, 19.1 percent of the 217.6 million adults age 18 and older in

the U.S. civilian noninstitutionalized population were reported as 

having received treatment for hypertension during the year 

(estimates not shown in a figure.) Overall, 45.3 percent of these 

adults used a diuretic, with females (49.5 percent) more likely to use

a diuretic than males (40.2 percent) (figure 1). 

Among adults reported as receiving treatment for hypertension in 

2003, diuretic use increased with age across the three age categories in our study. Elderly adults (those age 65 and over) were the 

most likely (52.6 percent) to use diuretics while adults ages 45 to 64 

were more likely (43.7 percent) to use these medications than adults 

ages 18 to 44 (26.7 percent) (figure 2). 

* See JNC 7 Express: The Seventh Report of the Joint National Committee on 

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure under the

National Heart, Lung, and Blood Institute at the National Institutes of Health, NIH 

Publication No. 03-5233, December 2003.
Black non-Hispanics who were reported as receiving treatment for hypertension in 2003 were more likely 

(53.2 percent) to use a diuretic than any other race/ethnicity group (figure 3). White non-Hispanics (45.6 

percent) were more likely to use these medications than Hispanics (34.8 percent) and other nonHispanics (33.0 percent). 

Adults with low incomes who were reported as receiving treatment for hypertension in 2003 were more 

likely (51.4 percent) to use a diuretic than those with middle incomes (44.3 percent) or high incomes (43.2 

percent) (figure 4). 

Among adults who were reported as receiving treatment for hypertension in 2003, there were no 

statistically significant differences in diuretic use by insurance status for adults less than 65 years old or 

for adults 65 and older (figure 5). 

In 2003, 49.8 percent of adults with less than a high school education who were reported as receiving 

treatment for hypertension used a diuretic during the year (figure 6). This was higher than the proportion 

for adults with a high school education (43.4 percent) and adults with at least some college education 

(44.6 percent). 

Among adults who were reported as receiving treatment for hypertension in 2003, those who reported 

better health were less likely to use diuretics. Adults who reported excellent, very good, or good health 

were less likely (43.4 percent) to use diuretics than adults in fair or poor health (51.5 percent) (figure 7). 

Data Source 

The estimates presented in this Statistical Brief were derived from the 2003 MEPS full-year consolidated 

data file and the 2003 MEPS prescribed medicines (PMED) file. Diuretics were identified by linking the 

PMED files to the Multum Lexicon. 

Definitions 

Identification of persons with hypertension 

In this brief, hypertensive adults were identified using household-reported information on conditions. 

Hypertensive adults were primarily identified using information on conditions that was recorded in the 

MEPS in connection with health care use (e.g., when a person is reported as purchasing a drug, the 

household respondent is asked what condition(s) the drug was intended to treat). Approximately 95 

percent of the hypertensive adults identified in this brief were reported to have purchased drugs, visited a 

doctor’s office, or had other health services to treat their high blood pressure during the year. Hypertensive adults were also identified through responses to a general question that asks whether a person 

had been bothered by any condition. About 5 percent of the hypertensive adults were identified only 

through this question; that is, they were not reported to have received any health services to treat their 

high blood pressure during the year. Questions that ask whether a doctor had ever told a person that he 

or she had hypertension were not used to identify hypertensive adults. 

Diuretic use 

Individuals were classified as having used a diuretic if they had one or more purchases of a prescribed 

diuretic medication during the year. This includes drugs with one active ingredient from the diuretic class 

as well as antihypertensive combination drugs that contain a diuretic along with an active ingredient from 

another class of antihypertensive drugs. All subclasses of diuretics (loop diuretics, potassium sparing 

diuretics, thiazide diuretics, carbonic anhydrase inhibitors, and miscellaneous diuretics) were included. 

Racial/ethnic classifications 

Classification by race/ethnicity was based on information reported for each family member. Respondents 

were asked if each family member's race was best described as black, white, or other. (In this report, 

“other” includes American Indians, Alaska Natives, Asians, Pacific Islanders, and people who reported 

multiple races.) They also were asked if each family member's main national origin or ancestry was 

Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or Chicano; other Latin American; or other 

Spanish. All adults whose main national origin or ancestry was reported in one of these Hispanic groups, 

regardless of racial background, were classified as Hispanic. Since the Hispanic grouping can include 
black Hispanics, white Hispanics, and other Hispanics, the race categories of black, white, and other do 

not include Hispanics. 

Income 

Income categories are based on the ratio of the family’s income to the Federal poverty thresholds, which 

control for the size of the family and the age of the head of the family. The following income categories 

are used in this report: 

– Poor/near poor: Adults in families with income of 125 percent of the poverty line or less, including those 

who reported negative income. 

– Low income: Adults in families with income from over 125 percent through 200 percent of the poverty 

line. 

– Middle income: Adults in families with income from over 200 percent through 400 percent of the poverty 

– High income: Adults in families with income over 400 percent of the poverty line. 

Health insurance status 

Individuals under age 65 were classified in the following three insurance categories, based on household 

responses to health insurance status questions: 

 – Any private health insurance: Individuals who, at any time during the year, had insurance that provides 

coverage for hospital and physician care (other than Medicare, Medicaid, or other public 

hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that 

provides coverage for a single service only, such as dental or vision coverage, was not included. 

 – Public coverage only: Individuals were considered to have public coverage only if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, and 2) 

they were covered by one of the following public programs at any point during the year: Medicare, 

Medicaid, or other public hospital/physician coverage. 

 – Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the 

entire year or period of eligibility for the survey. 

For individuals age 65 and older, the following insurance categories were used: 

 – Medicare plus private: Individuals who, at any time during the year, were covered by TRICARE or a 

supplemental private insurance policy in addition to Medicare. 

– Medicare plus other public coverage: Individuals were considered to have Medicare plus other public 

coverage if they were covered by Medicare and met both of the following criteria: 1) they were not 

covered by TRICARE or a supplemental private policy at any time during the year, and 2) they were 

covered by Medicaid or other public hospital/physician coverage in addition to Medicare. 

– Medicare HMO/Medicare only: This group includes adults who did not report any private or public 

supplemental insurance coverage and were enrolled in Medicare HMOs or had Medicare fee-forservice coverage only. 

– Missing: A small percentage of individuals age 65 and over were reported to have no Medicare 

coverage. These persons were excluded from figure 5. 

Perceived health status 

During each round of interviewing, the household respondent was asked to rate the health of each person 

in the family according to the following categories: excellent, very good, good, fair, or poor. For this report, 

the response categories excellent, very good, and good were collapsed, as were fair and poor. Health 

status was missing for a small percentage of individuals.

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 
References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Miller, G. E. and Doshi, A. K. Diuretic Use in the Treatment of Hypertension, by Selected Population 

Characteristics, 2003. Statistical Brief #119. March 2006. Agency for Healthcare Research and Quality, 

Rockville, Md. http://www.meps.ahrq.gov/papers/st119/stat119.pdf 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 1. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, overall and by sex, 2003

40.2

49.5

45.3

0

15

30

45

60

Overall Male Female

P

ercent

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 2. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, by age, 2003

43.7

52.6

26.7

0

15

30

45

60

18 to 44 45 to 64 65 and older

P

ercent
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 3. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, by race/ethnicity, 2003

53.2

34.8 33.0

45.6

0

15

30

45

60

White non-Hispanic Black non-Hispanic Hispanic Other non-Hispanic

P

ercent

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 4. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, by income, 2003

51.4

44.3 43.2

46.4

0

15

30

45

60

Poor/near poor Low income Middle income High income

P

ercent
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 5. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, by insurance status, 2003

41.2 40.9

53.6 52.3 52.3

39.3

0

15

30

45

60

Any private Public only Uninsured Medicare

only/HMO

 Medicare 

& private

 Medicare 

& public

P

ercent

Less than 65 65 and older 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 6. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, by education, 2003

43.4 44.6

49.8

0

15

30

45

60

Less than high school High school Some college

P

ercent
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003.

Figure 7. Percentage of adults reported as receiving treatment

for hypertension who used diuretics, by health status, 2003

51.5

43.4

0

15

30

45

60

Excellent/very good/good Fair/poor

P

ercent