Use of antihypertensive drug therapy in older persons in an academic nursing home.
OBJECTIVE
To determine the prevalence of hypertension and the appropriate treatment of hypertension in older persons in an academic nursing home.


METHODS
The charts of all persons aged > or = 59 years currently residing in a nursing home affiliated with Westchester Medical Center/New York Medical College were analyzed by two geriatrics fellows according to a protocol designed by one of the authors (W.S.A.).


METHODS
An academic nursing home affiliated with Westchester Medical Center/New York Medical College.


METHODS
The study population included 96 men and 159 women, mean age 77 +/- 9 years (range, 59-100 years).


RESULTS
Hypertension was present in 129 of 255 persons (51%). Clinical cardiovascular disease or target organ damage or diabetes mellitus was present in 121 of 129 persons (94%) with hypertension. Hypertension was poorly controlled in 21 of 129 persons (16%). Of 129 persons with hypertension, 70 (54%) were treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers, 61 persons (47%) with beta blockers, 43 persons (33%) with diuretics, 36 persons (28%) with calcium channel blockers, 5 persons (4%) with alpha blockers, and 5 persons (4%) with other antihypertensive drugs. Of 54 persons with hypertension and diabetes mellitus, 37 persons (69%) were treated with ACE inhibitors or angiotensin II type 1 receptor blockers. Of 58 persons with hypertension and coronary artery disease, 33 persons (57%) were treated with ACE inhibitors or angiotensin II type 1 receptor blockers, 31 persons (53%) with beta blockers, 20 persons (34%) with diuretics, 18 persons (31%) with calcium channel blockers, 2 persons (4%) with alpha blockers, and 4 persons (7%) with other antihypertensive drugs. Of 31 persons with hypertension and heart failure, only 5 persons (16%) had measurement of left ventricular ejection fraction. Of 31 persons with hypertension and heart failure, 30 persons (97%) were treated with diuretics, 21 persons (68%) with ACE inhibitors or angiotensin II type 1 receptor blockers, 18 persons (58%) with beta blockers, and 8 persons (26%) with calcium channel blockers.


CONCLUSIONS
Of older persons with hypertension in an academic nursing home, 16% had poor control of their hypertension. There was overuse of calcium channel blockers and alpha blockers and underuse of diuretics, beta blockers, and ACE inhibitors in treating hypertension. Physician education needs to be intensified to provide better medical care of older persons with hypertension through the use of optimal doses of drugs found to be effective and safe by evidence-based studies.
Ziesmer
Valerie
V
Department of Medicine, Divisions of Cardiology and Geriatrics, Westchester Medical Center/New York Medical College, Valhalla, New York 10804, USA.
Ghosh
Subrato
S
Aronow
Wilbert S
WS
D000046:Academic Medical Centers / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D009935:Organizational Affiliation; D015995:Prevalence
D000959:Antihypertensive Agents