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Drug treatment of hypertension in older persons in an academic hospital-based geriatrics practice
G Mendelson1, J Ness, W S Aronow
1Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USA.
Insights
Hypertension affects 58% of older adults. Treatment goals of <140/90 mm Hg were met in 70% of patients, with specific drug use varying by prior myocardial infarction or congestive heart failure.
Area of Science:
- Geriatrics
- Cardiology
- Public Health
Background:
- Hypertension is a prevalent condition in older adults.
- Effective management is crucial for preventing cardiovascular complications.
Purpose of the Study:
- To determine the prevalence of hypertension in older individuals.
- To analyze the utilization of antihypertensive medications, including in patients with prior myocardial infarction (MI) or congestive heart failure (CHF).
- To assess the rate of achieving blood pressure control to <140/90 mm Hg.
Main Methods:
- Retrospective chart analysis of 1819 older patients (mean age 80 years) from an academic, hospital-based geriatrics practice.
- Data collected from December 1997 to August 1998.
- Prevalence of hypertension, drug usage patterns, and blood pressure control were examined.
Main Results:
- Hypertension was identified in 58% (1051/1819) of the study population.
- Among hypertensive patients, 70% achieved a blood pressure <140/90 mm Hg.
- Specific drug prevalences included diuretics (49%), ACE inhibitors (42%), and beta-blockers (28%).
- In patients with prior MI, beta-blockers (59%) and ACE inhibitors (48%) were common.
- In patients with CHF, diuretics (100%) and ACE inhibitors (91%) were highly prevalent.
Conclusions:
- The study confirms a high prevalence of hypertension in older adults within an academic geriatric practice.
- Educational interventions appear to have influenced prescribing patterns, increasing the use of diuretics and beta-blockers.
- A significant majority (70%) of hypertensive older patients achieved target blood pressure control.
Objective:
To investigate the prevalence of hypertension in older persons, the prevalence of the different antihypertensive drugs used to treat hypertension, the prevalence of the different antihypertensive drugs used to treat hypertension in persons with prior myocardial infarction (MI) or congestive heart failure (CHF), and the prevalence of lowering the blood pressure to <140/90 mm Hg with therapy.
Design:
A retrospective analysis of charts from all older patients seen from December 1, 1997, through August 31, 1998, at an academic, hospital-based geriatrics practice was performed to investigate the prevalence of hypertension in older persons, the prevalence of different antihypertensive drugs used to treat hypertension, the prevalence of different antihypertensive drugs used to treat hypertension in persons with prior MI or CHF, and the prevalence of lowering the blood pressure to <140/90 mm Hg with therapy.
Setting:
An academic hospital-based geriatrics practice staffed by fellows in a geriatrics training program and fulltime faculty geriatricians.
Patients:
A total of 459 men and 1360 women, mean age 80 +/- 8 years (range 59 to 101 years), were included in the study.
Measurements And Main Results:
Hypertension was present in 1051 of the 1819 persons in the study (58%). Target organ damage, clinical cardiovascular disease, or diabetes mellitus was present in 738 (70%) of these 1051 persons. Of the 1051 persons with hypertension, 520 (49%) were treated with diuretics, 297 (28%) with beta-blockers, 445 (42%) with angiotensin-converting enzyme (ACE) inhibitors, 171 (16%) with calcium channel blockers, and 13 (1%) with other antihypertensive drugs; 41 (4%) received no antihypertensive therapy. The last blood pressure recorded on the chart was <140/90 mm Hg for 735 of the 1051 persons (70%) with hypertension. Of 306 persons with hypertension and prior MI, 182 (59%) were treated with beta-blockers, 146 (48%) with ACE inhibitors, 96 (31%) with diuretics, and 29 (9%) with calcium channel blockers. Of 103 persons with hypertension and CHF, 103 (100%) were treated with diuretics, 94 (91%) with ACE inhibitors, 22 (21%) with beta-blockers, and 3 (3%) with calcium channel blockers.
Conclusions:
The prevalence of hypertension in the 1819 older persons seen in an academic, hospital-based geriatrics practice was 58%. Educational efforts led to increased use of diuretics and beta-blockers and decreased use of calcium channel blockers in treating hypertension. The last blood pressure recorded on the chart was <140/90 mm Hg in 70% of older persons with hypertension in the study.
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