November 11, 2002Archives of Internal Medicine
Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults
Key result
Antihypertensive medication use increased over 9 years, improving blood pressure control (<140/90 mm Hg) from 37% at baseline to 49%, though half of participants remained uncontrolled.
Population
5888 adults 65 years and older from 4 US centers in the Cardiovascular Health Study.
Design
Cohort
Follow-up
9 years
Authors
Discussion
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Implication
Suboptimal BP control persists in older adults despite increased medication use; leaves open whether addressing underuse of preferred agents improves outcomes.
Key Points
- To assess time trends in the awareness, treatment, and control of high blood pressure, as well as medication class usage patterns, among older adults during the 1990s.
- Prospective cohort analysis of 5,888 adults aged 65 years and older recruited from 4 US centers in the Cardiovascular Health Study.
- Annual follow-up visits conducted from baseline (1989-1990) through 1998-1999 to evaluate blood pressure levels and antihypertensive medication use.
- Blood pressure control (<140/90 mm Hg) increased from 37% at baseline to 49% in 1999, while the overall treated proportion rose from 34.5% to 51.1%.
- Uncontrolled blood pressure persisted in 51% of hypertensive participants by 1999, predominantly driven by isolated mild-to-moderate elevations in systolic blood pressure.
- Among participants without coronary disease, the use of guideline-recommended low-dose diuretics and beta-blockers declined, whereas the use of calcium channel blockers and ACE inhibitors increased.
Study Design
Type
Cohort (n=5,888)
Multicenter
Yes
Structured PICO
P
Population
5888 adults 65 years and older from 4 US centers in the Cardiovascular Health Study.
O
Outcome
Control of BP to levels lower than 140/90 mm Hg and the prevalence of use of various classes of antihypertensive medicationssurrogate
Main Result
Absolute Event Rate: 49% vs 37%
While BP control improved in older adults during the 1990s, half remained uncontrolled and guideline-preferred agents were underused.
Cite This Study
Psaty et al. (2002) conducted a cohort in High blood pressure (n=5,888). Antihypertensive medications vs. Baseline (1989-1990) was evaluated on Control of blood pressure to levels lower than 140/90 mm Hg. Antihypertensive medication use increased over 9 years, improving blood pressure control (<140/90 mm Hg) from 37% at baseline to 49%, though half of participants remained uncontrolled.