Key result
Patients aged ≥80 years with hypertension had worse blood pressure control (OR 0.92; 95% CI 0.86-0.99) and were prescribed fewer medications than those aged 60-69 years.
Why the study?
Does age affect blood pressure control and the number of prescribed antihypertensive medications in outpatients with hypertension?
Cross-Sectional (n=59,207)
Yes
Does age affect blood pressure control and the number of prescribed antihypertensive medications in outpatients with hypertension?
Effect estimate: OR 0.92 (95% CI 0.86 to 0.99)
The oldest hypertension patients (≥80 years) have worse BP control but are treated less aggressively with fewer medications than younger patients, suggesting that controversy in treating this age group impacts actual clinical practice.
May indicate undertreatment in octogenarians; leaves open whether age-specific intensification improves control.
BACKGROUND: Despite guidelines recommending similar blood pressure (BP) treatment goals regardless of age, controversy exists regarding treating those > or = 80 years of age. Whether this affects current practice in terms of differences in BP control and number of prescribed antihypertensives by age is unknown. METHODS: This was a cross-sectional study of 59,207 outpatients with hypertension treated at 10 Veterans Health Administration sites. Outcome measures were BP control (< 140/90 mm Hg) and number of antihypertensive medications at the patient's last study visit. Uncontrolled BP was also categorized by whether systolic, diastolic, or both were elevated. RESULTS: Subjects 40 to 49 years and those 50 to 59 years of age had better BP control (adjusted odds ratios 1.35 [95% CI = 1.26 to 1.44] and 1.22 [CI = 1.17 to 1.28] respectively) compared with subjects 60 to 69 years of age; those 70 to 79 years of age and > or = 80 years had worse control (OR = 0.92 for both; respective CIs = 0.88 to 0.96 and 0.86 to 0.99). Antihypertensive medication use increased by successive decade to age 80 years, after which the trend reversed. Adjusted mean number of medications by age were: < 40 years, 2.60; 40 to 49, 2.82; 50 to 59, 2.91; 60 to 69, 3.01; 70 to 79, 3.03; > or = 80 years, 2.90 (P < .05 in pairwise comparisons). The trend of number of medications by age did not vary across hypertension categories, despite systolic hypertension increasing and diastolic hypertension decreasing with age. Subjects < 40 years of age were taking the fewest medications, followed by subjects > or = 80 years and then by those 40 to 49, 50 to 59, 70 to 79, and 60 to 69 years of age. CONCLUSIONS: The oldest hypertension patients, despite worse BP control, are being treated less aggressively with fewer medications than their younger counterparts (those 60 to 79 years of age). Our results suggest that current controversy in treating the oldest hypertensive patients is having an impact on actual practice.
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Borzecki et al. (2006) conducted a cross-sectional in hypertension (n=59,207). Age group (≥80 years) vs. Age 60 to 69 years was evaluated on BP control (< 140/90 mm Hg) (OR 0.92, 95% CI 0.86 to 0.99). Patients aged ≥80 years with hypertension had worse blood pressure control (OR 0.92; 95% CI 0.86-0.99) and were prescribed fewer medications than those aged 60-69 years.
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