Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents. SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) Study Group.
BACKGROUND
Hypertension is prevalent in the elderly, but an information gap remains regarding the old, frail, individuals with complex conditions living in long-term care.


OBJECTIVE
To analyze the patterns of antihypertensive drug therapy among elderly patients living in nursing homes to elucidate their conformity with consensus guidelines.


METHODS
We used a long-term care database that merged sociodemographic, functional, clinical, and treatment information on nearly 300000 patients admitted to the facilities of 5 US states between 1992 and 1994.


RESULTS
Hypertension was diagnosed in 80206 patients (mean age, 82.7+/-7.8 years). The prevalence was higher among women and among blacks. About one fourth of patients had 6 or more comorbid conditions; 26%, 22%, and 29% had concomitant diagnoses of coronary heart disease, congestive heart failure, and cerebrovascular disease, respectively. Seventy percent of patients were treated pharmacologically. Calcium channel blockers were the most common agents (26%), followed by diuretics (25%), angiotensin-converting enzyme inhibitors (22%), and beta-blockers (8%). The relative use of these drugs changed according to the presence of other cardiovascular conditions. Adjusting for potential confounders, the relative odds of receiving antihypertensive therapy were significantly decreased for the oldest subjects (> or =85 years old: odds ratio, 0.85; 95% confidence interval, 0.81-0.89) and those with marked impairment of physical (odds ratio, 0.77; 95% confidence interval, 0.73-0.81) and cognitive (odds ratio, 0.67; 95% confidence interval, 0.64-0.70) function.


CONCLUSIONS
Among very old, frail hypertensive patients living in nursing homes, the pattern of treatment seems not to follow recommended guidelines; age, functional status, and comorbidity appear to be important determinants of treatment choice.
Gambassi
G
G
Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy. giovannivgambassi@brown.edu
Lapane
K
K
Sgadari
A
A
Landi
F
F
Carbonin
P
P
Hume
A
A
Lipsitz
L
L
Mor
V
V
Bernabei
R
R
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044383:Black People; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015897:Comorbidity; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000453:epidemiology; D019992:Databases as Topic; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D001741:Black or African American
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics