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Prevalence, Clinical Correlates, and Treatment of Hypertension in Elderly Nursing Home Residents
Giovanni Gambassi, MD;
Kate Lapane, PhD;
Antonio Sgadari, MD;
Francesco Landi, MD;
Pierugo Carbonin, MD;
Anne Hume, PharmD;
Lewis Lipsitz, MD;
Vincent Mor, PhD;
Roberto Bernabei, MD;
for the SAGE (Systematic Assessment of Geriatric Drug Use via Epidemiology) Study Group
Arch Intern Med. 1998;158:2377-2385.
Background Hypertension is prevalent in the elderly, but an information gap remains regarding the old, frail, individuals with complex conditions living in long-term care.
Objective To analyze the patterns of antihypertensive drug therapy among elderly patients living in nursing homes to elucidate their conformity with consensus guidelines.
Subjects and Methods We used a long-term care database that merged sociodemographic, functional, clinical, and treatment information on nearly 300000 patients admitted to the facilities of 5 US states between 1992 and 1994.
Results Hypertension was diagnosed in 80206 patients (mean age, 82.7±7.8 years). The prevalence was higher among women and among blacks. About one fourth of patients had 6 or more comorbid conditions; 26%, 22%, and 29% had concomitant diagnoses of coronary heart disease, congestive heart failure, and cerebrovascular disease, respectively. Seventy percent of patients were treated pharmacologically. Calcium channel blockers were the most common agents (26%), followed by diuretics (25%), angiotensin-converting enzyme inhibitors (22%), and  -blockers (8%). The relative use of these drugs changed according to the presence of other cardiovascular conditions. Adjusting for potential confounders, the relative odds of receiving antihypertensive therapy were significantly decreased for the oldest subjects ( 85 years old: odds ratio, 0.85; 95% confidence interval, 0.81-0.89) and those with marked impairment of physical (odds ratio, 0.77; 95% confidence interval, 0.73-0.81) and cognitive (odds ratio, 0.67; 95% confidence interval, 0.64-0.70) function.
Conclusions Among very old, frail hypertensive patients living in nursing homes, the pattern of treatment seems not to follow recommended guidelines; age, functional status, and comorbidity appear to be important determinants of treatment choice.
From the Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy (Drs Gambassi, Sgadari, Landi, Carbonin, and Bernabei); Department of Community Health (Drs Gambassi, Lapane, and Mor) and Center for Gerontology and Health Care Research (Drs Gambassi, Lapane, and Mor), Brown University, Providence, RI; College of Pharmacy, University of Rhode Island, Kingston (Dr Hume); and Hebrew Rehabilitation Center for the Aged, Harvard Medical School, Boston, Mass (Dr Lipsitz).
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Franz H. Messerli, Tomasz Grodzicki, Zhanbin Feng, Giovanni Gambassi, Kate Lapane, Anne L. Hume, Pierugo Carbonin, and Roberto Bernabei
Arch Intern Med. 1999;159(14):1621-1622.
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