Management of older patients with hypertension in primary care: improvement on the rule of halves.
OBJECTIVE
the benefits of treatment of hypertension in older people are well-established but implementation of this knowledge may be sub-optimal. We have determined recent primary care management of older people with hypertension.


METHODS
we examined health records (n = 6986) of a 1 in 7 sample of patients aged 65-80 years from a random sample of practices (n = 51) in the former Northern Region of the UK, stratified by health authority, for the previous 6 years. We recorded documented risk factors, diagnosis of hypertension, three most recent blood pressure readings, current drug therapy and previous blood pressure lowering therapy, and presence of coexistent pathology.


RESULTS
blood pressure was defined as hypertensive (> or = 160/> or = 90 mmHg; one or both values above these limits), normotensive or undetermined using a validated algorithm. In 30% of patients, blood pressure status was undetermined. Thirty-five percent of subjects were found to be hypertensive. Of these, 70% were receiving antihypertensive treatment but only 30% of treated patients had controlled (< 150 and 90 mmHg) and 13% well controlled (< 140 and 85 mmHg) blood pressure. In all, 14% of older hypertensive patients were detected, treated and had their hypertension controlled. There were significant differences between practices in the proportion of hypertensive patients treated (P < 0.001) and in the proportion of hypertensive patients whose blood pressure was controlled (P < 0.01).


CONCLUSIONS
treatment of hypertension in older people in primary care has improved in terms of detection and treatment but in only one-third of patients is high blood pressure controlled. There remain important opportunities for prevention of stroke and myocardial infarction in this age group through achieving improved blood pressure control.
Duggan
S
S
Centre for Health Services Research, Department of Medicine (Geriatrics), University of Newcastle upon Tyne, UK.
Eccles
M P
MP
Steen
N
N
Jones
S
S
Ford
G A
GA
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004739:England; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011320:Primary Health Care; D016896:Treatment Outcome
D000959:Antihypertensive Agents