Hypertension has an high prevalence and is often undertreated among older adults. To identify factors associated with a definitively untreated or uncontrolled hypertension, we analised data from 692 persons (80% of those eligible) enrolled in the ICARe Dicomano (Insufficienza Cardiaca negli Anziani Residenti a Dicomano) study, a cross-sectional epidemiological survey of all persons aged 65+ years living in this small town nearby Florence (Italy). Hypertension was defined in the presence of high blood pressure (BP) values or of current pharmacological treatment. With the usual ≥140/90 mm Hg cut-off, the prevalence of hypertension was 72.3% in the whole study population. Optimally treated hypertensives (BP < 140/90 mmHg) were 8.2%; 23.8% were uncontrolled despite therapy (SBP 140-159 and DBP < 90 mmHg). We also utilized a higher cut-off to identify cases definitively undertreated. According to this BP limit, 380 persons were definitively hypertensives. Of them, 42.6% were untreated and 31.3% were uncontrolled. Logistic multivariate models, based on this cut-off, indicated that women and participants with associated coronary artery disease, stroke or with a Mini Mental State Examination score >21 were less likely to be untreated, while definitively uncontrolled hypertension had a negative association with a history of coronary artery disease (CAD) and, at an almost significant level, female gender. ACE-inhibitors and Ca-antagonists were the drugs most often prescribed. Prescription of Ca-antagonists was independently associated with male gender and a history of CAD. These results suggest that antihypertensive treatment is more accurate, in terms of both treatment prescription and patient's compliance, among geriatric patients with higher cardiovascular risk profile and substantially preserved cognitive function. However, these data also reinforce the current concept of substantial undertreatment of hypertensives in the general, unselected older population.
Pharmacological treatment of hypertension in elderly people living in Dicomano / Salti F.; Di Bari M.; Nardi M.; Bencini F.; Tonon E.; Ungar A.; Nesti A.; Marsilii A.; Masotti G.; Marchionni N.. - In: GIORNALE DI GERONTOLOGIA. - ISSN 0017-0305. - STAMPA. - 46:(1998), pp. 465-469.
Pharmacological treatment of hypertension in elderly people living in Dicomano
Di Bari M.;Bencini F.;Tonon E.;Ungar A.;Masotti G.;Marchionni N.
1998
Abstract
Hypertension has an high prevalence and is often undertreated among older adults. To identify factors associated with a definitively untreated or uncontrolled hypertension, we analised data from 692 persons (80% of those eligible) enrolled in the ICARe Dicomano (Insufficienza Cardiaca negli Anziani Residenti a Dicomano) study, a cross-sectional epidemiological survey of all persons aged 65+ years living in this small town nearby Florence (Italy). Hypertension was defined in the presence of high blood pressure (BP) values or of current pharmacological treatment. With the usual ≥140/90 mm Hg cut-off, the prevalence of hypertension was 72.3% in the whole study population. Optimally treated hypertensives (BP < 140/90 mmHg) were 8.2%; 23.8% were uncontrolled despite therapy (SBP 140-159 and DBP < 90 mmHg). We also utilized a higher cut-off to identify cases definitively undertreated. According to this BP limit, 380 persons were definitively hypertensives. Of them, 42.6% were untreated and 31.3% were uncontrolled. Logistic multivariate models, based on this cut-off, indicated that women and participants with associated coronary artery disease, stroke or with a Mini Mental State Examination score >21 were less likely to be untreated, while definitively uncontrolled hypertension had a negative association with a history of coronary artery disease (CAD) and, at an almost significant level, female gender. ACE-inhibitors and Ca-antagonists were the drugs most often prescribed. Prescription of Ca-antagonists was independently associated with male gender and a history of CAD. These results suggest that antihypertensive treatment is more accurate, in terms of both treatment prescription and patient's compliance, among geriatric patients with higher cardiovascular risk profile and substantially preserved cognitive function. However, these data also reinforce the current concept of substantial undertreatment of hypertensives in the general, unselected older population.
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