Diagnosis and Treatment of Isolated Systolic Hypertension in the Elderly: Results of a Survey Four Years Post-SHEP.
There is limited data evaluating the impact on clinical practice of the 1991 SHEP study. To assess present approaches and attitudes to ISH, we surveyed 135 physicians during the spring of 1995. A questionnaire was designed to assess the physician's definition of ISH, views on clinical importance and etiology of ISH, choice of pharmacological intervention (if any), and opinions regarding SHEP's influence on current approaches to the management of ISH. Surveys were distributed to physicians at the weekly Internal Medicine and Cardiology Grand Rounds at The Mt. Sinai Medical Center, New York, NY from February through April 1995. Data were analyzed via Lotus 1-2-3 spreadsheet (Release 3.1 Que Corp.) and responses to opinion statements were factor analyzed on Systat Version 5.0 software. The response rate was 63.7% (87 physician responses). Nearly 50% of the respondents had read the SHEP article and 82.6% had "heard of the study." Approximately 60% believed ISH should be defined in accordance with the SHEP guideline (SBP is greater than 160 mm Hg and DBP is less than 90 mm Hg). Thirty percent of physicians would initiate pharmacological treatment at a SBP less than or equal to 155 mm Hg for patients aged 65-74 years. Of the 85% of physicians (n equals 73) who opted to medicate, the patient's age strongly determined the SBP at which pharmacological treatment would be initiated. Whereas 66% of physicians would use drug therapy for patients aged 65-74 with a SBP less than or equal to 160 mm Hg, 54% and 45% of physicians would consider the same for patients aged 75-84 and 85+, respectively. Thirty eight percent of physicians chose thiazide diuretics as sole first-line therapy. CCB and ACE inhibitors were chosen by 26.8% and 19.7% of physicians, respectively. When compared to younger physicians (less than 60 yrs), older clinicians ( at or above 60 yrs) were more likely to agree that the detection of ISH was not important and that treatment of ISH is ineffective. Survey results demonstrate a definite consensus for initiation of pharmacological treatment in elderly patients with ISH. Of note, a significant percentage of physicians would initiate therapy at SBP less than or equal to 155 mm Hg. This is a level of pressure for which no epidemiological data exists to support treatment. With respect to specific pharmacological treatment of ISH, a clear consensus is still lacking. The increased use of ACE inhibitors and CCB compared with previous studies may have significant impact on the future of treatment costs for the elderly.
Ramakrishna
Gautam
G
Hypertension Section, Cardiovascular Institute Mount Sinai School of Medicine, New York, NY.
Schechter
Clyde B.
CB
Phillips
Robert A.
RA