 |
|
Use of Antihypertensive Drugs and Trends in Blood Pressure in the Elderly
Robert J. Glynn, ScD;
Dwight B. Brock, PhD;
Tamara Harris, MD;
Richard J. Havlik, MD;
Elizabeth A. Chrischilles, PhD;
Adrian M. Ostfeld, MD;
James O. Taylor, MD;
Charles H. Hennekens, MD
Arch Intern Med. 1995;155(17):1855-1860.
Abstract
| |
Background
During the 1980s data became available from randomized trials concerning the clear benefits of treating hypertension in the elderly. In three large communities, we examined the impact of these findings on rates of treatment, use of specific antihypertensive drugs, and rates of elevated blood pressure as well as distributions of levels.
Methods
In 1981 the National Institute on Aging initiated population-based cohort studies in the residents of three communities who were 65 years and older: East Boston, Mass; Washington and Iowa counties, Iowa; and New Haven, Conn. Participation rates ranged from 80% to 85% across sites with 10 294 community-dwelling participants in the combined cohorts. Baseline evaluation included inhome blood pressure assessment and medication inventory. Repeated in-home evaluations occurred 3 and 6 years after baseline and follow-up rates ranged from 71% to 88%.
Results
Use of antihypertensive drugs increased over time in all three communities: the age- and sex-adjusted rates of use were between 14% and 32% higher in 1988 and 1989 relative to 1982 and 1983. Parallel declines in the use of thiazide diuretics occurred in all three populations along with large increases in the use of angiotensin-converting enzyme inhibitors and calcium channel blockers. In East Boston and New Haven mean systolic blood pressure decreased substantially over time and the prevalence of elevated systolic pressure ( 160 mm Hg) decreased overall as well as by age and sex. In Iowa the mean levels of systolic blood pressure were lowest at baseline and increased slightly.
Conclusions
The reported evidence about the benefits of treatment for hypertension in the elderly was followed by substantial increases in treatment rates. The use of drugs with proven efficacy declined while the use of newer agents with theoretical advantages, not yet tested in clinical trials of mortality, increased. In the United States, the ongoing therapeutic efforts to lower elevated blood pressure in elderly populations may be contributing to the continuing decline in cardiovascular and stroke mortality.
(Arch Intern Med. 1995;155:1855-1860)
Author Affiliations
From the Division of Preventive Medicine and East Boston Neighborhood Health Center, Departments of Medicine (Drs Glynn, Taylor, and Hennekens) and Ambulatory Care and Prevention (Drs Glynn, Hennekens, and Taylor), Brigham and Women's Hospital and Harvard Medical School (Dr Hennekens), Boston, Mass; Epidemiology, Demography, and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Md (Drs Brock, Harris, and Havlik); Department of Preventive Medicine and Environmental Health, The University of Iowa, Iowa City (Dr Chrischilles); and Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (Dr Ostfeld).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A Collaborative Initiative to Improve the Care of Elderly Medicare Patients With Hypertension
Meehan et al.
American Journal of Medical Quality 2004;19:103-111.
ABSTRACT
Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults: The Cardiovascular Health Study
Psaty et al.
Arch Intern Med 2002;162:2325-2332.
ABSTRACT
| FULL TEXT
Residual Lifetime Risk for Developing Hypertension in Middle-aged Women and Men: The Framingham Heart Study
Vasan et al.
JAMA 2002;287:1003-1010.
ABSTRACT
| FULL TEXT
Antihypertensive Drug Therapy in Saskatchewan: Patterns of Use and Determinants in Hypertension
Bourgault et al.
Arch Intern Med 2001;161:1873-1879.
ABSTRACT
| FULL TEXT
Pulse Pressure and Mortality in Older People
Glynn et al.
Arch Intern Med 2000;160:2765-2772.
ABSTRACT
| FULL TEXT
Reducing Antihypertensive Medication Use in Nursing Home Patients
Froom and Trilling
Arch Fam Med 2000;9:378-383.
ABSTRACT
| FULL TEXT
A comparison of angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers and diuretic agents on reactive hyperemia in patients with essential hypertension: a multicenter study
Higashi et al.
J Am Coll Cardiol 2000;35:284-291.
ABSTRACT
| FULL TEXT
Trends in the prevalence and treatment of hypertension in Halifax County from 1985 to 1995
Wolf et al.
CMAJ 1999;161:699-704.
ABSTRACT
| FULL TEXT
Detection and Control of High Blood Pressure in the Community : Do We Need a Wake-Up Call?
Meissner et al.
Hypertension 1999;34:466-471.
ABSTRACT
| FULL TEXT
Heart Failure Survival Among Older Adults in the United States: A Poor Prognosis for an Emerging Epidemic in the Medicare Population
Croft et al.
Arch Intern Med 1999;159:505-510.
ABSTRACT
| FULL TEXT
Current and Remote Blood Pressure and Cognitive Decline
Glynn et al.
JAMA 1999;281:438-445.
ABSTRACT
| FULL TEXT
Prevalence, Clinical Correlates, and Treatment of Hypertension in Elderly Nursing Home Residents
Gambassi et al.
Arch Intern Med 1998;158:2377-2385.
ABSTRACT
| FULL TEXT
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Arch Intern Med 1997;157:2413-2446.
ABSTRACT
|
