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Trends in hypertension prevalence, treatment, and control: in a well-defined older population
W H Barker1, J P Mullooly, K L Linton
1University of Rochester Medical Center, New York 14642, USA. Barker@prevmed.rochestr.edu
Insights
Medical attention for high blood pressure (HBP) in seniors improved significantly, with treatment and control rates rising. However, a gap remains in addressing HBP in the elderly, a high-risk group.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- Hypertension (HBP) poses significant cardiovascular risks, particularly in the elderly population.
- Assessing trends in HBP management within this demographic is crucial for public health initiatives.
Purpose of the Study:
- To evaluate the trends in prevalence, treatment, and control of high blood pressure (HBP) among individuals aged 65 and older.
- To identify changes in antihypertensive medication use over time in the elderly population.
Main Methods:
- Analysis of random population samples from a large HMO for the years 1967, 1974, 1981, and 1988.
- Review of medical records to obtain ambulatory blood pressure readings and treatment data for individuals aged 65+.
- Prevalence defined by blood pressure thresholds or current antihypertensive medication use.
Main Results:
- HBP prevalence ranged from 44% to 53% in the elderly population studied.
- The proportion of elderly individuals with HBP on treatment increased from 25% in 1967 to 60% in 1988.
- Controlled HBP rates rose from 8% to 34% between 1967 and 1988, with significant declines in mean systolic and diastolic blood pressure.
- Isolated systolic hypertension prevalence remained stable, while medication patterns shifted towards beta-blockers and newer drug classes.
Conclusions:
- While HBP treatment and control have improved in the elderly, a gap persists compared to younger populations.
- The findings highlight progress in managing HBP in seniors but underscore the need for continued focus on this high-risk group.
- Shifting medication trends suggest evolving clinical practices in elderly hypertension management.
Abstract:
To assess medical attention focused on hypertension (HBP) in the elderly, this study examines trends in HBP prevalence, treatment, and control status in a defined population of persons > or = 65 years of age enrolled in a large HMO. Random samples of approximately 400 persons were drawn for the years 1967, 1974, 1981, and 1988. First recorded ambulatory pressures, available on over 90% of subjects in each period, were obtained from medical records. Prevalence of HBP (SBP > or = 160 and/or DBP > or = 95, and/or taking anti-HBP drugs) ranged between 44% to 53%. Proportion with HBP on treatment increased from 25% in 1967 to 60% in 1988 (P<.001); proportion on treatment and controlled (SBP < 160, DBP < 95) increased from 8% to 34% (P<.001). Mean population SBP declined from 155.2 in 1967 to 144.0 in 1988 (P<.001); mean DBP declined from 85.2 to 81.2 (P<.001). Proportion with isolated systolic hypertension (ISH) (SBP > or = 160, DBP < 90) remained unchanged at 12% to 14%. Use of diuretics and adrenergic antagonist agents declined while use of beta blockers and newer classes of anti-HBP drugs increased significantly among treated hypertensives in the 1980s. These findings parallel HBP trends in younger adults from National Health Survey data though we find evidence of a substantial gap in addressing the problem in the elderly, who constitute the population at greatest risk of cardiovascular complications of HBP.