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Age and Ageing Advance Access published online on January 23, 2006
Age and Ageing, doi:10.1093/ageing/afj052
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received October 11, 2005
Accepted December 19, 2005

Article

Management of hypertension in the oldest old: a study in primary care in New Zealand

Hugh Senior 1 *, Craig S. Anderson 2, Mei-Hua Chen 1, Ron Haydon 3, Dinah Walker 1, Dean Fourie 1, Steven Lillis 4, and John Gommans 5

1 Clinical Trials Research Unit, School of Population Health, University of Auckland, Auckland, New Zealand
2 Clinical Trials Research Unit, School of Population Health, University of Auckland, Auckland, New Zealand; The George Institute for International Health, The University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia
3 Department of Geriatrics, Auckland City Hospital, Auckland, New Zealand
4 Department of General Practice, University of Auckland, Hamilton Campus, Auckland, New Zealand
5 Department of Geriatrics, Hawke’s Bay Hospital, New Zealand

* To whom correspondence should be addressed.
Hugh Senior, E-mail: h.senior{at}ctru.auckland.ac.nz


  Abstract

Background: the benefits of blood pressure (BP) lowering are well established except in the oldest old, and suboptimal control of hypertension has been found in many different populations.

Objective: to assess the frequency of hypertension and its adequacy of management in the oldest old in primary care.

Design: a cross-sectional study.

Setting: sixty-seven general practitioners (GPs) in three urban centres in New Zealand.

Methods: we conducted structured reviews of medical records for all ambulatory people aged ≥80 years who were registered with a participating GP. Hypertensive status and BP control were classified according to standard criteria. Logistic regression analyses were used to identify independent factors for BP control.

Results: medical records of 3,068 people (mean age 85 years, 64% female) revealed 56% to be hypertensive, of whom 94% were on treatment and 58% had controlled BP levels. Major co-morbid conditions were common among hypertensive people, and half of them had associated target organ damage. Histories of stroke, heart disease and hypercholesterolaemia were independent factors for good BP control.

Conclusion: a large proportion of the oldest old were currently receiving anti-hypertensive therapy, and most had adequately controlled BP. Previous vascular disease was the most important factor for both BP treatment and control. These findings indicate a high level of uptake of cardiovascular guidelines for older people.

Keywords: aged 80 and over, survey, blood pressure, hypertension, primary care, elderly.
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