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Risk Factors in Optimal Management of Hypertension in Elderly Patients Following 2017 American College of
Zachary Walder1, Satwiki Prasad2, Adriana Guevara1
1Cooper University Health Care, Camden, NJ, USA.
Insights
Suboptimal and uncontrolled hypertension in the elderly are linked to Black-Indigenous-and-People-of-Color (BIPOC) race, higher BMI, and conditions like hyperlipidemia and left ventricular hypertrophy. These factors are crucial for managing hypertension in older adults.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- The 2017 American Heart Association guidelines advocate for blood pressure (BP) control below 130/80 mmHg for optimal hypertension management.
- Elderly patients present unique challenges in achieving and maintaining target BP levels, necessitating research into associated factors.
- Understanding factors contributing to suboptimal and uncontrolled hypertension is vital for refining treatment strategies in geriatric populations.
Purpose of the Study:
- To identify and analyze factors associated with suboptimal and uncontrolled hypertension among elderly patients.
- To compare the prevalence of specific comorbidities and demographic characteristics across different BP control groups.
Main Methods:
- Retrospective review of suburban outpatient records for patients aged 65 years and older with hypertension.
- Classification of patients into three groups: optimally controlled (OC; BP <130/80 mmHg), sub-optimally controlled (SOC; BP 130-139/80-89 mmHg), and uncontrolled (UC; BP ≥140/90 mmHg).
- Statistical comparison of demographic data, body mass index (BMI), and comorbidities between the groups.
Main Results:
- Out of 1311 patients, 46.5% were OC, 29.9% SOC, and 23.6% UC.
- Black-Indigenous-and-People-of-Color (BIPOC) patients showed a higher prevalence in the UC group compared to the OC group (29.0% vs 21.5%, P=.011).
- Elevated BMI, hyperlipidemia, and left ventricular hypertrophy (LVH) were significantly associated with higher odds of SOC and UC.
- Other comorbidities like transient ischemic attack, atrial fibrillation, HFpEF, osteoarthritis, and malignancy were more prevalent in the SOC group.
Conclusions:
- BIPOC race, elevated BMI, hyperlipidemia, and left ventricular hypertrophy are significantly associated with suboptimal and uncontrolled hypertension in the elderly.
- These findings highlight the need for targeted interventions and closer monitoring for these risk factors in geriatric hypertension management.
- Further research should explore the underlying mechanisms and effective strategies to address these disparities and improve BP control in older adults.
Introduction/Objectives:
The 2017 American Heart Association hypertension management guidelines recommended optimal control of blood pressure under 130/80 mmHg. We aimed to study the factors associated with suboptimal and uncontrolled hypertension in the elderly patients.
Methods:
We performed a retrospective review of suburban outpatient records of patients with hypertension, aged 65 years and older, and grouped into optimally controlled (OC; BP <130/80 mmHg), sub-optimally controlled (SOC; BP 130-139/80-89 mmHg), and uncontrolled (UC; BP≥140/90 mmHg) groups; and compared the associations of variables.
Results:
Among 1311 patients, there were 610 (46.5%) patients in OC, 391 (29.9%) in SOC, and 310 (23.6%) in UC groups. Mean ages were comparable (OC = 78 ± 8.1, SOC = 77 ± 7.4, UC = 78 ± 7.3 years; P = .760). In all groups, the majority of patients were White followed by BIPOC (Black-indigenous-and-other-people-of-color; OC = 78.5% vs 21.5%, SOC = 78.3% vs 21.7%, and UC = 71% vs 29%, respectively). There were more BIPOC patients in UC compared to OC group (29.0% vs 21.5%; P = .011). Mean body-mass-index (BMI) of patients in SOC and UC groups were greater than OC group (27.9 ± 6.3 vs 26.9 ± 6.3 kg/m2; P = .047; 28.1 ± 6.3 vs 26.9 ± 6.3 kg/m2; P = .027; respectively). There were significantly higher associations of certain comorbidities in SOC compared to OC group, such as transient ischemic attack (12.3% vs 3.6%; P < .001), hyperlipidemia (72.4% vs 56.2%; P < .001), atrial fibrillation (19.2% vs 11%; P < .001), HFpEF (5.4% vs 1.5%; P < .001), osteoarthritis (38.9% vs 30.5%; P = .006), malignancy (32.2% vs 19.5%; P < .001), and left ventricular hypertrophy (LVH; 27.4% vs 15.9%; P < .001). Logistic regression analysis showed that when compared to BIPOC, White race had lower odds of UC (OR = 0.63, 95% CI = 0.45-0.90). For every unit increase in BMI, there were greater odds of SOC (OR = 1.04, 95% CI = 1.01-1.06) and UC (OR = 1.04, 95% CI = 1.01-1.16). Patients with hyperlipidemia and LVH had greater odds of SOC (OR = 1.72, CI = 95% 1.25-2.37; and OR = 2.13, 95% CI = 1.02-4.43; respectively).
Conclusion:
In patients with sub-optimal and uncontrolled hypertension, there is a significantly higher association of BIPOC race, elevated BMI, hyperlipidemia, and left ventricular hypertrophy.
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