Treatment of hypertension in an elderly outpatient population in the Netherlands

Abstract

Background: The treatment of older patients with hypertension has been controversial—in addition to uncertainty regarding appropriate blood pressure (BP) targets in the very old, there are concerns that excessive BP lowering could result in adverse events such as falls, stroke, and cognitive problems. The Hypertension in the Very Elderly Trial (HYVET), however, found that lowering BP in patients aged ≥80 years was associated with decreased morbidity and mortality. Objective: This study compared the findings of HYVET with data from a population of elderly outpatients with hypertension in a clinical practice setting. Methods: This was a retrospective study of prospectively collected data from patients aged ≥80 years with a history of hypertension who visited a geriatric diagnostic day clinic in the Netherlands in 2004. The data were analyzed to determine how many patients were being prescribed antihypertensive medication, how many would have been eligible for HYVET, how many achieved adequate BP control, and whether reaching BP goals was associated with the number and type of antihypertensive medications received or with eligibility for HYVET. Results: During 2004, 518 patients aged ≥80 years visited the geriatric diagnostic day clinic, of whom 147 met the criteria for inclusion in this study. One hundred forty-one patients (95.9%) were receiving antihypertensive medication, although only 52 (35.4%) would have been eligible for HYVET. Dementia, which was an exclusion criterion in HYVET, was the major reason for ineligibility (70 [47.6%]). Greater proportions of patients in this study had comorbidities compared with the HYVET population (stroke: 22.4% vs 6.7%, respectively; myocardial infarction: 7.5% vs 3.1%; heart failure: 11.6% vs 2.9%; diabetes mellitus: 21.1% vs 6.8%). At the time of the clinic visit, 50.3% of patients had adequate BP control, as defined in HYVET (systolic BP <150 mm Hg and diastolic BP <80 mm Hg). Levels of BP control were similar in patients who would and would not have been ineligible for HYVET. Only the mean (SD) number of antihypertensive medications received was significantly associated with the achievement of BP control compared with failure to achieve adequate BP control (2.2 [1.0] vs 1.8 [1.1], respectively; P < 0.05). Conclusions: Based on the findings of this study, the benefits of treating elderly patients with hypertension in clinical practice may be lower than those reported by HYVET. The study results support the current recommendation that all patients with hypertension should be treated with >1 antihypertensive medication if adequate control is not achieved at low doses of a single medication.