Blood pressure below target levels in treated older patients with hypertension: prevalence and associated factors.

INTRODUCTION AND OBJECTIVES: European hypertension guidelines recommend avoiding treatment targets of systolic blood pressure (BP) < 120 mmHg or diastolic BP < 70 mmHg. This study estimated the prevalence of these low BP levels and their associated factors in older treated patients with hypertension assessed at home, where BP measurement is increasingly common and useful for follow-up. METHODS: Cross-sectional study of adults aged ≥ 65 years from the general population of Madrid in 2017. BP was calculated as the mean of the second and third standardized measurements. RESULTS: Among 1560 treated patients with hypertension (mean age, 72.1 years; 51.8% women), the prevalence of BP < 120/70 mmHg was 29% (95%CI, 26.8-31.3). In 36.4% of these cases, both systolic and diastolic BP were below target. The prevalence of BP < 120/70 mmHg was significantly higher in patients with (vs without) heart failure (51.1% vs 28.4%), atrial fibrillation (46.8% vs 27.1%), and antihypertensive polytherapy (≥ 3 drugs vs 1) (37.8% vs 27.8%), and in women (35.1% vs 22.5% in men). After adjustment for confounders, the odds ratios for low BP were: heart failure, 2.21; atrial fibrillation, 2.28; female sex, 1.73; and antihypertensive polytherapy, 1.53. CONCLUSIONS: One in 3 treated older patients with hypertension has home BP < 120/70 mmHg and shows a characteristic sociodemographic and clinical profile (female sex and higher prevalence of heart failure, atrial fibrillation, and antihypertensive polytherapy). These features may help identify patients at increased risk of having BP values below recommended targets. Full English text available from: www.revespcardiol.org/en.