title: Blood pressure target attainment in the background of guidelines: the very elderly in Swiss primary care.
abstract: BACKGROUND
  There are only a few trials for the very elderly population (>79 years). No consensus, which blood pressure (BP) goals and substances should be applied, has been found yet. This survey was undertaken to investigate how octogenarians are treated and attain BP targets in the Swiss primary care.
  
  
  METHODS
  Data from 4594 hypertensive patients were collected within 7 days. Eight hundred and seventy-seven patients met the requirement to be >79 years. We assessed substances/combinations and investigated pulse pressure and target blood pressure attainment (TBPA) using three different recommendations [Canadian Hypertension Education Program (CHEP), Swiss Society of Hypertension (SSH), European Society of Hypertension-European Society of Cardiology (ESH-ESC)]. Secondarily, we compared TBPA attained by angiotensin-converting enzyme inhibitor (ACEI)/diuretic (D), angiotensin receptor blocker (ARB)/D and calcium channel blocker (CCB)/D with any other dual therapy and investigated whether Ds/beta-blockers (BBs) or Ds/renin angiotensin-converting enzyme inhibitors (RAAS-Is) lead to higher TBPA. Finally, we assessed the impact of drug administration, practical work experience, location and specialization of GPs on TBPA.
  
  
  RESULTS
  Octogenarians attained target blood pressure (TBP) between 44% (ESH-ESC) and 74% (SSH). Optimal/normal BP was reached in 22.8% of patients. Pulse pressure <65 mmHg was shown in 66.4% of patients. Monotherapy was most commonly applied followed by dual single-pill combination with ARB/D (46.5%) or ACEI/D (36.0%). No benefit in TBPA was found comparing a RAASI/D and CCB/D treatment with any other dual combination. There was also no difference between BB/D and RAAS-I/D combination therapy and between single-pill combination and dual free combinations.
  
  
  CONCLUSIONS
  GPs adhere to the use of substances proven in outcome trials and attain high TBP. No difference in meeting BP goals could be found using different drug classes. There is an unmet need to harmonize recommendations and to add additional information for the treatment of octogenarians.
authors.affiliation: Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, 7925 Cape Town, South Africa. Hendrik.Schaefer@gmx.ch
authors.forename: Hans Hendrik
authors.initials: HH
authors.lastname: Schäfer
authors.forename: Isabella
authors.initials: I
authors.lastname: Sudano
authors.forename: Gian-Reto
authors.initials: GR
authors.lastname: Theus
authors.forename: Peter
authors.initials: P
authors.lastname: Zilla
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.forename: Michel
authors.initials: M
authors.lastname: Burnier
mesh_terms: D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D005260:Female; D006040:Goals; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012016:Reference Values; D013557:Switzerland; D016896:Treatment Outcome