Blood pressure control and management of very elderly patients with hypertension in primary care settings in Spain

Abstract

This study aimed to determine the clinical profile, blood pressure (BP) control rates, therapeutic management and physicians' therapeutic behavior regarding very elderly hypertensive patients. A total of 1540 hypertensive patients 80 years old on antihypertensive therapy and receiving care in primary care settings in Spain were included in this cross-sectional study. The mean patient age was 83.4±3.1 years, 61.9% of patients were women and 49.3% of patients had cardiovascular disease. Of the patients, 27.7% were on monotherapy and 72.3% were on combined therapy (47.4% on two antihypertensive agents and 24.9% on three or more antihypertensive agents). A total of 40.8% (95% confidence interval (CI): 38.4-43.3%) of patients achieved BP goals (<140/90 mm Hg; <130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). Patients with uncontrolled BP were more likely to have metabolic syndrome, diabetes, obesity, a history of cardiovascular disease, ischemic heart disease, renal disease and stroke and were more frequently smokers. Physicians modified the antihypertensive regimens for 27.4% (95% CI: 23.9-30.8%) of the patients with uncontrolled BP, and the addition of another antihypertensive agent was the most frequent modification. With regard to the physicians' perception of patients' BP control, the BPs of 44.1% of the patients with uncontrolled BP were considered well controlled by the physicians.

Declining blood pressure and intensification of blood pressure management among people over 80 years

“…In the present study, women tended to have higher recorded BP values than men, irrespective of treatment status. A similar pattern of sex disparity in BP measurement was noted in a Spanish study [37]. This finding appears to support the view that men who reach older ages may in some respects be healthier than their female counterparts [38,39].…”

Trends in Hypertension Control Among the Older Population of Spain From 2000 to 2001 to 2008 to 2010

“…33 However, in Spain and the United States, physicians failed to increase medications in most uncontrolled hypertensive patients, especially in the elderly. 34,35 Reluctance to initiate combination therapy in older patients was often because of safety concerns such as orthostatic hypotension. [4][5][6][7] Also, as reported in the United States, 32 we found that the proportion of treated uncontrolled patients taking 1 to 2 medications (a proxy for treatment inertia in our study) fell from 89.3% in 2000 to 2001to 81.9% in 2008 to 2010, and the proportion on ≥3 medications (a proxy for apparent treatment-resistant hypertension) rose from 10.6% in 2000 to 18.1% in 2010 (data not presented).…”

Caracterización de Adultos Mayores con Hipertensión Arterial pertenecientes al Policlínico José Martí Pérez

“…La literatura revisada plantea que hasta los 50 años los varones aportan un mayor número de casos de HTA, lo que se invierte al pasar esta edad, ya que las mujeres después de la quinta década de la vida inician la menopausia, y debido a la disminución de las hormonas sexuales femeninas quedan más expuestas a sufrir esta enfermedad [12,13].…”