Abstract
BackgroundIt is unknown to what extent General Practitioners (GPs) manage hypertension (HT) differently in older patients, as compared to younger age groups. The purpose of our study was to compare HT management in older patients to younger age groups.MethodsWe performed a retrospective cohort study of patients of 159 GP's practices in the Integrated Primary Care Information (IPCI) database. The study period lasted from September 2010 through December 2012.The study population consisted of all patients aged 60 years or older with at least one blood pressure (BP) measurement during the inclusion period, without pre-existent HT, diabetes mellitus (DM) or atherosclerotic cardiovascular disease at time of study start.Study outcomes were a diagnosis of HT within one month after cohort entry and the use of antihypertensive medication within 4 months after cohort entry in HT diagnosed patients.We compared the incidence of outcomes between the age groups, stratified by systolic blood pressure (SBP). Logistic regression analysis was used to assess the influence of age-adjusted SBP Z-scores, age and gender on the outcomes.ResultsWe included 19,500 patients from 159 GP’s practices of whom 1,181 (6.1 %) were newly diagnosed with HT. Corrected for age-adjusted SBP, older patients were less likely to be diagnosed with HT (odds ratio per year age increase 0.98, p < 0.001). Corrected for age-adjusted SBP, no significant effect of age on the probability of treatment in newly diagnosed HT patients was observed (p = 0.82).ConclusionsThis study showed that GPs are less inclined to diagnose HT with increasing patient age, but do not withhold treatment when they diagnose HT in older patients.
Highlights
It is unknown to what extent General Practitioners (GPs) manage hypertension (HT) differently in older patients, as compared to younger age groups
Patient characteristics Our cohort consisted of 19,500 patients aged 60+ with at least one blood pressure (BP) measurement and without a diagnosis of HT, diabetes mellitus (DM) or arterial cardiovascular disease or antihypertensive medication prior to the first BP measurement
Increasing life expectancy will lead to larger numbers of older patients, yet the optimal management of HT in this age group has not been elucidated. In this respect there are indications that BP target values will depend on features, such as frailty, in older patients
Summary
It is unknown to what extent General Practitioners (GPs) manage hypertension (HT) differently in older patients, as compared to younger age groups. The purpose of our study was to compare HT management in older patients to younger age groups. Evidence on the effectiveness of treatment of hypertension (HT) in patients of 80 years and older is conflicting [1,2,3,4]. Older patients were ignored in Dutch guidelines as patients up to 65 years old were treated according to their risk estimate of atherosclerotic cardiovascular disease, for which blood pressure (BP) was one of the criteria [5]. In 2012 the Dutch cardiovascular risk management guidelines [7] set systolic blood pressure (SBP) target values below 150–160 mmHg in older patients.
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