 |
|
Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults
The Cardiovascular Health Study
Bruce M. Psaty, MD, PhD;
Teri A. Manolio, MD, PhD;
Nicholas L. Smith, PhD;
Susan R. Heckbert, MD, PhD;
John S. Gottdiener, MD;
Gregory L. Burke, MD, MS;
Joel Weissfeld, MD;
Paul Enright, MD;
Thomas Lumley, PhD;
Neil Powe, MD, MPH, MBA;
Curt D. Furberg, MD, PhD
Arch Intern Med. 2002;162:2325-2332.
Background Control of high blood pressure (BP) in older adults is an important part of public health efforts at prevention.
Objective To assess recent time trends in the awareness, treatment, and control of high BP and in the use of medications to treat high BP.
Methods In the Cardiovascular Health Study, 5888 adults 65 years and older were recruited from 4 US centers. At baseline, participants underwent an extensive examination that included the measurement of BP, use of medications, and other risk factors. Participants were followed up with annual visits that assessed BP and medication use from baseline in 1989-1990 through the examination in 1998-1999. The primary outcome measures were control of BP to levels lower than than 140/90 mm Hg and the prevalence of use of various classes of antihypertensive medications.
Results The awareness, treatment, and control of high BP improved during the 1990s. The proportions aware and treated were higher among blacks than whites, though control prevalences were similar. For both groups combined, the control of high BP to lower than 140/90 mm Hg increased from 37% at baseline to 49% in 1999. The 51% whose BP was not controlled generally had isolated mild to moderate elevations in systolic BP. Among treated persons, the improvement in control was achieved in part by a mean increase of 0.2 antihypertensive medications per person over the course of 9 years. Improved control was also achieved by increasing the proportion of the entire Cardiovascular Health Study population that was treated for hypertension, from 34.5% in 1990 to 51.1% in 1999. Time trends in antihypertensive drug use were pronounced. Among those without coronary disease, the use of low-dose diuretics and  -blockers decreased, while the use of newer agents, such as calcium channel blockers, angiotensin-converting enzyme inhibitors, and  -blockers increased.
Conclusions While control of high BP improved in the 1990s, about half the participants with hypertension had uncontrolled BP, primarily mild to moderate elevations in systolic BP. Low-dose diuretics and -blockers—the preferred agents since 1993 according to the recommendations of the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure—remained underused. More widespread use of these agents will be an important intervention to prevent the devastating complications of hypertension, including stroke, myocardial infarction, and heart failure.
From the Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (Dr Psaty), Epidemiology (Drs Smith and Heckbert), and Biostatistics (Dr Lumley), University of Washington, Seattle; the Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Manolio); St Francis Hospital, Roslyn, NY (Dr Gottdiener); Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Burke and Furberg); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Weissfeld); Respiratory Sciences, Tucson, Ariz (Dr Enright); and the Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University, Baltimore, Md (Dr Powe).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999-2006
Plantinga et al.
Hypertension 2009;54:47-56.
ABSTRACT
| FULL TEXT
Consistency of Care and Blood Pressure Control among Elderly African Americans and Whites with Hypertension
Howard et al.
J Am Board Fam Med 2009;22:307-315.
ABSTRACT
| FULL TEXT
Cost Sharing and the Initiation of Drug Therapy for the Chronically Ill
Solomon et al.
Arch Intern Med 2009;169:740-748.
ABSTRACT
| FULL TEXT
Antihypertensive Prescriptions for Newly Treated Patients Before and After the Main Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Results and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines
Muntner et al.
Hypertension 2009;53:617-623.
ABSTRACT
| FULL TEXT
Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT
Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003
Curtis et al.
Arch Intern Med 2008;168:418-424.
ABSTRACT
| FULL TEXT
Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT
Tackling therapeutic inertia: role of treatment data in quality indicators
Guthrie et al.
BMJ 2007;335:542-544.
FULL TEXT
Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
FULL TEXT
Clinical Events in High-Risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-Converting Enzyme Inhibitor in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Leenen et al.
Hypertension 2006;48:374-384.
ABSTRACT
| FULL TEXT
Blood Pressure Lowering for Primary and Secondary Prevention of Stroke
Zhang et al.
Hypertension 2006;48:187-195.
FULL TEXT
Have ALLHAT, ANBP2, ASCOT-BPLA, and So Forth Improved Our Knowledge About Better Hypertension Care?
Sawicki and McGauran
Hypertension 2006;48:1-7.
FULL TEXT
Clinical Trial Investigators and Their Prescribing Patterns: Another Dimension to the Relationship Between Physician Investigators and the Pharmaceutical Industry
Psaty and Rennie
JAMA 2006;295:2787-2790.
FULL TEXT
Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
FULL TEXT
Epidemiology of Uncontrolled Hypertension in the United States
Wang and Vasan
Circulation 2005;112:1651-1662.
FULL TEXT
Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community
Lloyd-Jones et al.
JAMA 2005;294:466-472.
ABSTRACT
| FULL TEXT
Hypertension Management in the Elderly Has Improved: Ontario Prescribing Trends, 1994 to 2002
Tu et al.
Hypertension 2005;45:1113-1118.
ABSTRACT
| FULL TEXT
Hypertensive Therapy: Part II
Franco et al.
Circulation 2004;109:3081-3088.
FULL TEXT
Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension
Tierney et al.
Ann Fam Med 2004;2:209-217.
ABSTRACT
| FULL TEXT
Ethnic Differences in Antihypertensive Medication Use in the Elderly
Raji et al.
The Annals of Pharmacotherapy 2004;38:209-214.
ABSTRACT
| FULL TEXT
Hypertension Control: How Well Are We Doing?
Borzecki et al.
Arch Intern Med 2003;163:2705-2711.
ABSTRACT
| FULL TEXT
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Chobanian et al.
Hypertension 2003;42:1206-1252.
ABSTRACT
| FULL TEXT
The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial
Lear et al.
Eur Heart J 2003;24:1920-1927.
ABSTRACT
| FULL TEXT
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report
Chobanian et al.
JAMA 2003;289:2560-2571.
ABSTRACT
| FULL TEXT
Hypertension Prevalence and Stroke Mortality Across Populations
Staessen et al.
JAMA 2003;289:2420-2422.
FULL TEXT
Stopping Medical Research to Save Money: A Broken Pact With Researchers and Patients
Psaty and Rennie
JAMA 2003;289:2128-2131.
FULL TEXT
|
