title: The treatment of hypertension in care home residents: a systematic review of observational studies.
abstract: OBJECTIVE
  To describe the prevalence of hypertension in care home residents, its treatment, change in treatment over time, and the achievement of blood pressure (BP) control.
  
  
  METHODS
  The PubMed, Cochrane, Embase, and PsychINFO databases were searched for observational studies involving care home residents with a diagnosis of hypertension. The search was limited to English language articles involving adults and humans published from 1990 onward. Abstracts and titles were reviewed with eligible articles read in full. Bibliographies were examined for further relevant studies. The final selection of studies was then analyzed and appraised.
  
  
  RESULTS
  Sixteen articles were identified for analysis, of which half were studies carried out in the United States. The prevalence of hypertension in care home residents was 35% (range 16%-71%); 72% of these were on at least 1 antihypertensive (mean 1.5 antihypertensives per individual), with diuretics being the most common. The prevalence of hypertension in study populations was greater in more recent studies (P = .004). ACEi/ARBs (P = .001) and β-blockers (P = .04) were prescribed more frequently in recent studies, whereas use of calcium-channel blockers and diuretics remained unchanged over time. The number of antihypertensives prescribed per patient was higher (correlation 0.332, P = .009), whereas fewer patients achieved target BP (correlation -0.671, P = .099) in more recent studies.
  
  
  CONCLUSIONS
  Hypertension is common in care home residents and is commonly treated with antihypertensive drugs, which were prescribed more frequently in more recent studies but with no better BP control. These studies indicate a tendency toward increasing polypharmacy over time, with associated risk of adverse events, without demonstrable benefit in terms of BP control.
authors: Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Nottingham, UK. Electronic address: tomas.welsh@nottingham.ac.uk.
authors: Tomas
authors: T
authors: Welsh
authors: Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Nottingham, UK.
authors: John
authors: J
authors: Gladman
authors: Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Nottingham, UK.
authors: Adam L
authors: AL
authors: Gordon
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008134:Long-Term Care; D064887:Observational Studies as Topic; D019338:Polypharmacy; D015995:Prevalence; D012112:Residential Facilities
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
keywords: Hypertension; antihypertensive; long term care; systematic review