Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #120

March 2006 

Trends in the Use of Diuretics to Treat 

Hypertension, 1997 and 2003 Highlights 

 Among U.S. adults ages 

18 and older who were 

reported as receiving 

treatment for hypertension, 

the overall proportion using 

diuretics increased from 

39.8 percent in 1997 to 

45.3 percent in 2003. 

 The proportion of females 

reported as receiving 

treatment for hypertension 

who used a diuretic increased from 43.8 percent 

in 1997 to 49.5 percent in 

2003 while males’ use of 

diuretics rose from 34.3 to 

40.2 percent. 

 Diuretic use among adults 

who were reported to have 

treatment for hypertension 

increased regardless of 

health status as the proportion with use increased,

from 1997 to 2003, for 

those in fair or poor health 

and for those in excellent, 

very good, or good health. 

Alok Doshi, MBA and G. Edward Miller, PhD 

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 6 guidelines, 

which were issued in 1997, and JNC 7 guidelines, which were issued

in 2003, both recommend diuretics as first-line drugs in the treatment

of uncomplicated hypertension. JNC 7 guidelines also state that 

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

pressure treatment should usually include a diuretic.* 

This Statistical Brief presents estimates based on data from the 

Household Component of the Medical Expenditure Panel Survey 

(MEPS-HC) on trends from 1997 to 2003 in diuretic use in the U.S. 

civilian noninstitutionalized population. The sample is composed of 

adults ages 18 and older who were reported to have received

treatment for hypertension during the year. Trends in diuretic use are 

examined for this population overall and for 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 1997, 14.8 percent of adults 18 and older in the U.S. civilian 

noninstitutionalized population were reported to have received 

treatment for hypertension during the year; by 2003, the proportion

of adults reported to have received treatment for hypertension had 

increased to 19.1 percent (estimates not shown in a figure). 

Among all adults who were reported as receiving treatment for hypertension, the proportion using a 

diuretic increased from 39.8 percent in 1997 to 45.3 percent in 2003 (figure 1). The proportion of women 

who used a diuretic increased from 43.8 percent in 1997 to 49.5 percent in 2003 while male’s use of 

diuretics rose from 34.3 to 40.2 percent. 

Among elderly adults (those 65 and older) who were reported to have received treatment for hypertension, the proportion using diuretics increased from 47.6 percent in 1997 to 52.6 percent in 2003 (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; and The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment 

of High Blood Pressure, Archives of Internal Medicine, November 1997. 
Increased use was also observed among adults ages 45 to 64 as the proportion using diuretics grew from 

35.2 to 43.7 percent over this time period. For young adults (those 18 to 44), the percentage of persons 

with diuretic use was similar for 1997 and 2003. 

For black non-Hispanic adults who were reported to have received treatment for hypertension, the 

proportion using diuretics grew from 45.0 percent in 1997 to 53.2 percent in 2003 (figure 3). Over the 

same time period, the proportion of white non-Hispanics using diuretics grew from 40.4 percent to 45.6 

percent. 

Diuretic use among adults who were reported to have received treatment for hypertension also increased 

for three of the four income groups when comparing the years 1997 and 2003. The proportion using 

diuretics rose from 38.7 percent to 46.4 percent for the poor/near poor, from 44.0 percent to 51.4 percent 

for those with low incomes, and from 34.5 percent to 43.2 percent for those with high incomes (figure 4). 

In the middle income category, approximately 44 percent of adults used a diuretic in 1997 and in 2003. 

Among adults 65 and older who were reported to have received treatment for hypertension, diuretic use 

for those with Medicare HMO or with Medicare fee-for-service coverage only increased from 42.4 percent 

in 1997 to 53.6 percent in 2003. Among adults less than 65, the proportion of privately insured persons 

who used a diuretic increased from 31.9 to 39.3 percent. 

Among adults 18 and older who were reported to have treatment for hypertension, the proportion with 

diuretic use increased for two of three education categories from 1997 to 2003. For those with less than a 

high school education, it rose from 44.3 to 49.8 percent; and for those with at least some college 

education, it rose from 35.7 to 44.6 percent (figure 6). 

Diuretic use increased from 1997 to 2003 regardless of health status. Among persons who were reported 

to have treatment for hypertension, the proportion using a diuretic increased from 45.8 to 51.5 percent for 

those in fair or poor health and from 37.5 to 43.4 percent for those in excellent, very good, or good health 

(figure 7). 

Data Source 

The estimates presented in this Statistical Brief were derived from the 1997 and 2003 full-year 

consolidated data files and the 1997 and 2003 MEPS prescribed medicines (PMED) files. 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. Results are presented for Hispanics, white non-Hispanics and black nonHispanics. Results are not presented for other non-Hispanics because the sample for this group was too 

small to support reliable estimates. 

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/ 

CHAMPUS (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/CHAMPUS, 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/ 

CHAMPUS 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/CHAMPUS 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 

Doshi, A K. and Miller, G. E. Trends in the Use of Diuretics to Treat Hypertension, 1997 and 2003. 

Statistical Brief #120. March 2006. Agency for Healthcare Research and Quality, Rockville, Md. 

http://meps.ahrq.gov/mepsweb/data_files/publications/st120/stat120.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,

1997 and 2003

Figure 1. Percentage of adults reported 

as receiving treatment for hypertension who

used diuretics, overall and by sex, 1997 and 2003

40.2

49.5

43.8

34.3

39.8

45.3

0

15

30

45

60

Overall Male Female

1997 2003

P

ercent

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

1997 and 2003

Figure 2. Percentage of adults reported 

as receiving treatment for hypertension

who used diuretics, by age, 1997 and 2003

43.7

52.6

47.6

35.2

26.0 26.7

0

15

30

45

60

18 to 44 45 to 64 65 and older

1997 2003

P

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

1997 and 2003

Figure 3. Percentage of adults reported 

as receiving treatment for hypertension who

used diuretics, by race/ethnicity*, 1997 and 2003

53.2

34.8

40.4

45.0

27.8

45.6

0

15

30

45

60

White non-Hispanic Black non-Hispanic Hispanic

1997 2003

P

ercent

*Results are not presented for persons in the other non-Hispanic category due to an insufficient sample in 1997.

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

1997 and 2003

Figure 4. Percentage of adults reported 

as receiving treatment for hypertension who

used diuretics, by income, 1997 and 2003

51.4

44.3 43.2

34.5

44.0 44.1

38.7

46.4

0

15

30

45

60

Poor/near poor Low income Middle income High income

1997 2003

P

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

1997 and 2003

Figure 5. Percentage of adults reported 

as receiving treatment for hypertension who

used diuretics, by insurance status, 1997 and 2003

50.5

44.0

40.9

53.6 52.3

31.9

39.2

34.0

42.4

52.3

41.2 39.3

0

15

30

45

60

Private Public Uninsured Medicare

only/HMO

 Medicare 

& private

 Medicare 

& public

1997 2003

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,

1997 and 2003

Figure 6. Percentage of adults reported 

as receiving treatment for hypertension

who used diuretics, by education, 1997 and 2003

43.4 44.3 44.6

40.7

35.7

49.8

0

15

30

45

60

Less than high school High school Some college

1997 2003

P

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

1997 and 2003

Figure 7. Percentage of adults reported 

as receiving treatment for hypertension

who used diuretics, by health status, 1997 and 2003

51.5

37.5

45.8 43.4

0

15

30

45

60

Excellent/very good/good Fair/poor

1997 2003

P

ercent