[Statement of initial therapy of elderly patients with hypertension in Wakayama prefecture]

In order to evaluate the characteristics of initial therapy for elderly hypertensive patients in Wakayama prefecture, a case-card survey was performed in February 1997. The investigation consisted of blood pressure when starting therapy, initial physical examination and laboratory tests, and the initial drug therapy, and it's effects 3 months later. The initial physical examination and laboratory tests were the diagnostic procedures for determining the presence of target organ damage, they included electrocardiogram (ECG), chest X-rays, echocardiogram (UCG), funduscopy and urinalysis. Data of 7,647 cases from 156 facilities were obtained. These cases were divided into 2 groups, a non-elderly group (under 65 years, 3,396 cases) and an elderly group (65 years or over, 4,012 cases). The blood pressure at the start of pharmacological treatment was 174.9 +/- 17.4/93.7 +/- 11.0 mmHg (mean +/- SD) in the elderly group, and 170.6 +/- 17.8/98.6 +/- 11.2 mmHg in the non-elderly group. Systolic blood pressure in the elderly group was higher than in that the non-elderly group and diastolic blood pressure was lower in the elderly group than that in the non-elderly group. Cases of ECG (98.3% vs 71.3%; the non-elderly group vs the elderly group), chest X-ray (86.5% vs 65.2%), UCG (27.1% vs 23.7%), urinary test (96.0% vs 69.3%), examination of ophthalmic fundi (27.0% vs 24.3%), were much lower in the elderly group than in the non-elderly group. The rate of positive findings of left ventricular hypertrophy by ECG criteria (24.8% vs 20.3%), cardiomegaly by chest X-p (35.3% vs 26.6%), proteinuria by urinary test (14.8% vs 12.9%) was lower in the elderly than non-elderly. Details of drug use in non-elderly vs elderly were as follows; calcium antagonists (47.3% vs 51.9%), angiotensin converting enzyme inhibitor (ACE-I) (14.2% vs 12.2%), diuretics (6.3% vs 10.2%), beta-blockers (11.2% vs 4.7%), alpha-blockers (1.4% vs 1.3%), others (1.5% vs 2.4%), multiple (13.7% vs 12.5%), undefined (4.2% vs 4.7%). Sufficient hypotensive effects were obtained in 61.5% of the non-elderly, and 68.5% of the elderly. Initial physical examination to assess target organ damage was lower in the elderly than the non-elderly. It was thought necessary to be corrected. The incidence of main antihypertensive drugs in the elderly were Ca antagonists, ACE-I and diuretics. Treatment trends met the Japanese guideline on treatment of hypertension in the elderly.