Why the study?
It was unknown whether clinical practice reflects guideline recommendations for managing hypertension in older people and if adherence varies by overall health status.
What proportion of older people attain NICE guideline blood pressure targets within 1 year of a new hypertension diagnosis, and what are the predictors of target attainment?
What proportion of older people attain NICE guideline blood pressure targets within 1 year of a new hypertension diagnosis, and what are the predictors of target attainment?
Nearly half of older people with newly diagnosed hypertension do not achieve guideline blood pressure targets within 1 year, and target attainment appears unrelated to frailty or multi-morbidity, suggesting a lack of tailored management in these vulnerable groups.
Answers are grounded in this paper and cite their sources.
Nearly half of older adults with new hypertension miss targets within a year; hypothesis-generating for comorbidity-linked success and needs prospective confirmation.
BACKGROUND: it is not known if clinical practice reflects guideline recommendations for the management of hypertension in older people and whether guideline adherence varies according to overall health status. AIMS: to describe the proportion of older people attaining National Institute for Health and Care Excellence (NICE) guideline blood pressure targets within 1 year of hypertension diagnosis and determine predictors of target attainment. METHODS: a nationwide cohort study of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65 years newly diagnosed with hypertension between 1st June 2011 and 1st June 2016. The primary outcome was attainment of NICE guideline blood pressure targets as measured by the latest blood pressure recording up to 1 year after diagnosis. Predictors of target attainment were investigated using logistic regression. RESULTS: there were 26,392 patients (55% women, median age 71 [IQR 68-77] years) included, of which 13,939 (52.8%) attained a target blood pressure within a median follow-up of 9 months. Success in attaining target blood pressure was associated with a history of atrial fibrillation (OR 1.26, 95% CI 1.11, 1.43), heart failure (OR 1.25, 95% CI 1.06, 1.49) and myocardial infarction (OR 1.20, 95% CI 1.10, 1.32), all compared to no history of each, respectively. Care home residence, the severity of frailty, and increasing co-morbidity were not associated with target attainment following adjustment for confounder variables. CONCLUSIONS: blood pressure remains insufficiently controlled 1 year after diagnosis in nearly half of older people with newly diagnosed hypertension, but target attainment appears unrelated to baseline frailty, multi-morbidity or care home residence.
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Todd et al. (2023) studied this question.
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