NATIONAL EXAMINATION SURVEY ON BLOOD PRESSURE OF OLDER AND VERY OLD PEOPLE IN GERMANY 2022-2023: WHY SELF-REPORTS, MEASUREMENTS AND MEDICATION DATA ARE NEEDED

Abstract

Objective: The National Study on Health of Older People in Germany “Gesundheit 65+” aimed to provide up-to-date information on the health of older adults in Germany including blood pressure (BP) measurements at home by a study nurse. Design and method: Nationally representative examination survey of the population aged 65 years and older residing in Germany and with sufficient German language skills, using two-stage population registry sampling from 128 sample points from June 2022 to April 2023. Participation of physically or cognitively impaired persons was possible via proxy interviews and consent from legal representatives. Recruitment and data collection used a mixed-mode design. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above140 mm Hg, or mean diastolic BP (DBP) at or above 90 mm Hg, or the use of antihypertensives (ATC-codes C02 antihypertensives, C03 diuretics, C07 beta-blockers, C08 calcium-channel blockers or C09 ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results: The “Gesundheit 65+” examination survey included 1,493 participants and 1,475 (98.8%) had successful BP measurements (763 men and 712 women aged 65 to 100 years). External quality control showed very good standardization of BP measurements in the home environment. Central BP data were available from 1,356 participants. Based on self-reported diagnoses alone the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported physician diagnoses, standardized BP measurements and medication. Conclusions: Our study shows very good feasibility, acceptability and data completeness of standardized BP measurements using home visits. The prevalence of hypertension would be greatly underestimated in the absence of examination survey data with standardized measurements and detailed recording of medication.