Blood pressure control and physicians’ therapeutic behavior in a very elderly Spanish hypertensive population

Abstract

This study sought to assess blood pressure (BP) control rates by determining the factors associated with poor BP control, therapeutic management and physicians' therapeutic behavior among elderly Spanish hypertensive patients in a primary care setting. This cross-sectional multicenter study included hypertensive patients at least 80 years of age in primary care settings throughout Spain who were on pharmacologic treatment. BP was considered well controlled at o140/90 mm Hg (o130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). A total of 923 patients were included (83.3±3.5 years; 62.9% women). Almost two-thirds (64.0%) of the patients were taking a combined therapy (68.7%; 2 drugs) and approximately one-third (35.6%; 95% CI 32.6-38.7) of the patients attained BP goals. Physicians modified the antihypertensive treatment in 26.1% (95% CI 22.3-29.9) of patients with uncontrolled BP, which most frequently involved the addition of another drug (47.6%). Predictive factors for no BP control and no therapeutic modification in patients with uncontrolled BP included diabetes (OR 2.8 (95% CI 2.0-3.9); Po0.0001) and mistaken physician perceptions about BP control (OR 108.1 (95% CI 40.5-288.6); Po0.0001), respectively. Only three out of 10 hypertensive patients 80 years or older in Spain achieved the BP goals. Physicians only modified the treatment in one out of four patients with uncontrolled BP. Diabetes was associated with a threefold increase in the likelihood of uncontrolled BP, and the mistaken physician perceptions about BP control were associated with a 100-fold rise in the probability of not modifying antihypertensive therapy.

Susceptibility Genes in Hypertension

“…Reasons for this suboptimal response include adherence, differential dosing, and possibly genetic variants that alter the metabolism, clearance and target of the drugs [173]. Due to the pathophysiologic heterogeneity of hypertension, antihypertensive drugs act on numerous specific lowering-blood pressure systems.…”

“…Despite the availability of multiple antihypertensive drug classes, including thiazide diuretics, -blockers, ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers, interindividual variation in response to antihypertensive agents is common [172,173]. Recent estimate suggest that less than 35% of treated patients achieve both systolic and diastolic blood pressure control [174,175].…”

Treatment of hypertension in the elderly: data from an international cohort of hypertensives treated by cardiologists

“…Our data also confirm previous findings from other reports in Europe (and Canada), indicating BP control in only 20 --30% (47% in Canada) of treated patients, irrespective of age. 18,19 However, SBP control rates in elderly patients have to been seen in the light of the fact, that target SBP (o140 mm Hg in non-diabetic patients) is rarely achieved even in clinical trials. Therefore, the recommendation to lower BP in the elderly to the same level as in younger patients (o140/90 mm Hg for non-diabetics) has been recently considered as a 'non-evidence-based' approach, even though the benefits of BP lowering in the elderly are undisputed.…”

Pharmacogenomics of Antihypertensive Drugs: Past, Present and Future

“…Despite numerous efficacious drug classes, and many drugs within each class, blood pressure (BP) control rates among hypertensives are dismal. Global estimates suggest less than 35% of hypertensives have both systolic and diastolic BP control [3], with similar estimates from the USA [4] and other countries [5,6]. These poor rates of BP control are not explained by lack of treatment, as one study estimated approximately 30% of treated hypertensives take one antihypertensive drug, 40% take two antihypertensives and 30% take three or more antihypertensives [3].…”