Prevalence and management of uncontrolled hypertension in French patients aged over 80 years.
BACKGROUND
The rate of uncontrolled hypertensives aged >80 years is not well known. The available literature on this topic has used the threshold <140/90 mmHg, whereas there is now a consensus for a different target: systolic blood pressure (SBP)<150 mmHg.


OBJECTIVE
This prospective observational population-based study sought to assess the frequency and management of uncontrolled hypertension in French patients aged ≥80 years.


METHODS
Nine hundred and seventy-one treated hypertensive outpatients were evaluable (204 recruited by cardiologists, 767 by general practitioners [GPs]; mean age 84.8 ± 3.8 years; 57.8% women).


RESULTS
The frequency of SBP ≥ 150 mmHg was 36.6% (44.6% in cardiologists' patients and 34.4% in GPs' patients). The frequency of satisfaction with SBP ≥ 150 mmHg was 22.0% for cardiologists (32.6% if diastolic blood pressure [DBP] <90 mmHg and 9.5% if ≥90 mmHg; P=0.008) and 30.4% for GPs (51.7% if DBP <90 mmHg and 13.2% if ≥90 mmHg; P<0.0001). Non-diabetic status (for cardiologists) and DBP <90 mmHg (for cardiologists and GPs) were independent determinants of SBP being considered acceptable. Accordingly, in patients with an SBP level ≥ 150 mmHg that was considered too high, treatment was reinforced more often if DBP was ≥90 mmHg (82.3%) than <90 mmHg (68.5%).


CONCLUSIONS
In France, hypertension is uncontrolled in more than one in three elderly hypertensives. Physicians are aware that SBP should be lowered to <150 mmHg in patients aged>80 years, but when the target is not reached they are less likely to increase treatment if DBP is <90 mmHg.
Inserm, CIC1402, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Université de Poitiers, CIC1402, 86000 Poitiers, France; Université de Poitiers, UFR médecine et pharmacie, 86000 Poitiers, France. Electronic address: stephanie.ragot@chu-poitiers.fr.
Stéphanie
S
Ragot
CHU de Poitiers, cardiologie, 86000 Poitiers, France; Laboratoire MOVE (EA 6314), université de Poitiers, 86000 Poitiers, France.
Philippe
P
Sosner
Clinique Villette, cardiologie, 59240 Dunkerque, France.
François
F
Dievart
Université de Poitiers, UFR médecine et pharmacie, 86000 Poitiers, France; CHU de Poitiers, cardiologie, 86000 Poitiers, France.
Daniel
D
Herpin
D000367:Age Factors; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001794:Blood Pressure / Q000187:drug effects*; D004351:Drug Resistance; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome
D000959:Antihypertensive Agents
Blood pressure; Elderly; Hypertension; Pression artérielle; Pression pulsée; Pulse pressure; Quality of health care; Qualité de prise en charge; Sujets âgés