Management of hypertension in the oldest old: a study in primary care in New Zealand

BACKGROUND: The benefits of blood pressure (BP) lowering are well established except in the oldest old, and suboptimal control of hypertension has been found in many different populations. OBJECTIVE: To assess the frequency of hypertension and its adequacy of management in the oldest old in primary care. DESIGN: a cross-sectional study. SETTING: Sixty-seven general practitioners (GPs) in three urban centres in New Zealand. METHODS: We conducted structured reviews of medical records for all ambulatory people aged > or = 80 years who were registered with a participating GP. Hypertensive status and BP control were classified according to standard criteria. Logistic regression analyses were used to identify independent factors for BP control. RESULTS: Medical records of 3,068 people (mean age 85 years, 64% female) revealed 56% to be hypertensive, of whom 94% were on treatment and 58% had controlled BP levels. Major co-morbid conditions were common among hypertensive people, and half of them had associated target organ damage. Histories of stroke, heart disease and hypercholesterolaemia were independent factors for good BP control. CONCLUSION: A large proportion of the oldest old were currently receiving anti-hypertensive therapy, and most had adequately controlled BP. Previous vascular disease was the most important factor for both BP treatment and control. These findings indicate a high level of uptake of cardiovascular guidelines for older people.