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Hypertension in elderly people in a Swedish primary care district
Insights
Hypertension management in primary care shows significant blood pressure reduction but higher cardiovascular risks in younger males (60-69). Older hypertensives (70-80) had similar outcomes despite less treatment, suggesting age impacts hypertension
Area of Science:
- Cardiology
- Geriatrics
- Primary Health Care
Background:
- Hypertension is a significant risk factor for cardiovascular diseases.
- Effective management of hypertension in primary care settings is crucial for patient outcomes.
- Age-related differences in hypertension's impact on cardiovascular health require further investigation.
Purpose of the Study:
- To compare cardiovascular disease risks and outcomes in hypertensive individuals aged 60-69 managed in primary care versus age-matched controls.
- To evaluate the long-term mortality and cardiovascular morbidity in hypertensive pensioners (aged 70) compared to non-hypertensive pensioners.
- To analyze the influence of age on hypertension as a cardiovascular risk indicator.
Main Methods:
- Retrospective study comparing 124 hypertensives (60-69 years) with 124 controls on blood pressure, BMI, lifestyle, and cardiovascular disease history.
- Prospective cohort study of pensioners (born 1902-1903), comparing a subcohort of 39 hypertensive individuals (at age 70) with 105 non-hypertensive individuals.
- Analysis included blood pressure measurements, antihypertensive drug treatment rates, cardiovascular disease incidence, and mortality data.
Main Results:
- In the retrospective study, blood pressure was reduced by 37/24 mmHg in males and 40/24 mmHg in females; 75% achieved target BP (<180/100 mmHg).
- Male hypertensives (60-69 years) had higher odds of stroke (7.7) and cardiovascular diseases (4.3) compared to controls.
- No significant differences in mortality or cardiovascular morbidity were found between hypertensive and non-hypertensive pensioners at age 70.
- Hypertensives aged 60-69 showed higher risks than those aged 70-80, despite the older group having higher baseline BP and less treatment.
Conclusions:
- Primary care management effectively lowers blood pressure in hypertensive patients aged 60-69.
- Male hypertensives aged 60-69 managed in primary care face elevated risks for stroke and cardiovascular diseases.
- Hypertension's role as a cardiovascular risk indicator appears to differ significantly between hypertensive individuals above 60 years.
Abstract:
In a retrospective study, 124 hypertensives aged 60-69 years, and taken care of by primary health care, were compared with 124 age and sex matched controls with regard to blood pressure, body mass index, smoking and alcohol habits as well as cardiovascular diseases. Blood pressure, mean +/- SEM (mm Hg) was reduced by 37/24 in males and 40/24 in females. Drug treatment was given to 93 per cent of the patients. Our goal of treatment - blood pressure 180/100 or below - was obtained in 75 per cent of the patients. Cardiovascular diseases were more common in male hypertensives than in their controls. The relative odds of stroke in male hypertensives treated within the primary health care organisation was estimated to 7.7 (1.3-45.3) and of cardiovascular diseases to 4.3 (1.7-10.1). In a ten year prospective cohort study of all pensioners in the primary care district, born in 1902 and 1903, a subcohort of pensioners with hypertension and under medical treatment when they were 70 years old (n = 39) was compared with the subcohort of pensioners without hypertension at this age (n = 105). This study comprised 342 person-years in the former subcohort and 889 person-years in the latter. No significant differences in mortality nor in cardiovascular morbidity were found between the subcohorts. The results of the two studies showed higher risks for male hypertensives aged 60-69 years who are taken care of by primary health care compared with those aged 70-80 years in spite of the latter group being older, having higher systolic blood pressure at the examinations and less degree of antihypertensive drug treatment. This shows that hypertension as a risk indicator for cardiovascular diseases may differ between age groups above 60 years.