Blood pressure control and treatment is low, especially among older women with hypertension

07/21/05

Compared to current national guidelines, rates of blood pressure control in the community are low, especially among older women, according to a new study in the July 27 issue of JAMA.

"Elderly persons are among the fastest growing segments of the U.S. population and they have the highest prevalence of hypertension [high blood pressure]," according to the authors of the study. "Despite numerous trials demonstrating the benefits of blood pressure lowering among older individuals with hypertension, available data suggest that rates of treatment and control are suboptimal."

Donald M. Lloyd-Jones, M.D., Sc.M., from the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues from the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass., analyzed data collected between January 1, 1990 and December 31, 1999 from that community-based cohort study to determine the current prevalence, patterns, treatment, control, and risks of hypertension in persons aged 80 years or older compared with younger individuals. There were 5,296 participants (2,317 men and 2,979 women) who were categorized by age: younger than 60 years, 60 to 79 years, or 80 years or older. Hypertension was defined as systolic blood pressure greater than or equal to 140 mm Hg (millimeters of mercury) or diastolic blood pressure greater than or equal to 90 mm Hg. Current national guidelines define normal blood pressure as systolic blood pressure 120 or less and diastolic blood pressure of 80 or less mm Hg. Patients were followed for up to 6 years for development of cardiovascular disease events.

"Prevalence of hypertension and drug treatment increased with advancing age, whereas control rates were markedly lower in older women (systolic < 140 and diastolic < 90 mm Hg)," the researchers found. "For ages younger than 60 years, 60 to 79, and 80 years and older, respectively, control rates were 38 percent, 36 percent, and 38 percent in men and 38 percent, 28 percent, and 23 percent in women." The researchers note that "the overall prevalence of treatment among participants with hypertension was 68.9 percent."

Among participants 80 years of age or older, major cardiovascular events occurred in 9.5 percent of those with normal blood pressure, 19.8 percent of the prehypertension group, 20.3 percent of the stage 1 hypertension group, and 24.7 percent of the stage 2 or treated hypertension group.

"Despite a wealth of evidence suggesting that thiazide diuretics (a type of medication) are the most cost effective agents for blood pressure reduction, and that they are particularly efficacious among the elderly, we found overall low rates of thiazide use, particularly among men," the researchers write. "We observed high prevalence of use of more expensive agents such as ACE inhibitors and other classes of drugs (e.g., alpha blockers), although data supporting their efficacy in older hypertensive patients are limited."

"With the aging of the population, the burden of hypertension is expected to increase significantly," the authors write. "It is rare to escape the development of hypertension with aging; even for individuals free of hypertension at age 65 years, the remaining lifetime risk of developing hypertension is approximately 90 percent." The authors conclude: "Short-term risks for cardiovascular disease are substantial, indicating the need for greater efforts at safe, effective risk reduction among the oldest patients with hypertension."

(JAMA. 2005; 294:466 472. Available pre-embargo to the media at http://www.jamamedia.org.)

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