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[Statement of initial therapy of elderly patients with hypertension in Wakayama prefecture]
Hisashi Ohmori1, Takuzo Hano, Shuhei Ito
1Department of Cardiovascular Medicine, Wakayama Medical University.
Insights
This study evaluated initial hypertension therapy in elderly patients, finding that while treatment effects were sufficient, diagnostic examinations for target organ damage were less frequent in older individuals. This highlights a need for improved diagnostic practices in elderly hypertensive care.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Context:
- Hypertension management in elderly populations presents unique challenges.
- Initial diagnostic workups for target organ damage in hypertensive patients vary by age group.
- Japanese treatment guidelines for hypertension in the elderly exist.
Purpose:
- To evaluate the characteristics of initial antihypertensive therapy in elderly hypertensive patients.
- To compare diagnostic procedures and treatment outcomes between elderly and non-elderly hypertensive patients.
- To assess adherence to treatment guidelines for elderly hypertension.
Summary:
- A 1997 survey in Wakayama prefecture analyzed 7,647 hypertensive cases (elderly vs. non-elderly).
- Elderly patients had higher systolic and lower diastolic blood pressure, received less frequent target organ damage assessments (ECG, X-ray, urinalysis), but showed sufficient hypotensive effects (68.5%).
- Calcium antagonists, ACE inhibitors, and diuretics were common in the elderly, aligning with Japanese guidelines.
Impact:
- Identifies a gap in diagnostic evaluations for target organ damage in elderly hypertensive patients.
- Suggests a need to enhance screening protocols for older individuals with hypertension.
- Provides insights into current antihypertensive drug usage patterns and treatment efficacy in Japan.
Abstract:
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.