Current 27 - Older Adults Frequently Undertreated for Hypertension

Summary

Hypertension prevalence increases with advancing age, and helping older patients reach goal blood pressure can be challenging due to conflicting guidelines on age-based targets. A recent review in Hypertension found that, for older adults whose hypertension was assessed during a primary care visit, appropriate medication regimen intensification occurred for only 30%.¹

The review compiled 10 years of data, spanning 2008 to 2018, from the National Ambulatory Medical Care Survey. Blood pressure medication changes were reviewed for appropriateness in accordance with these guidelines: the 2017 American College of Cardiology/American Heart Association (Age ≥ 65, intensify when systolic blood pressure [SBP] ≥ 130), the 2018 European Society of Cardiology (Age > 65 and ≤ 80, intensify when SBP ≥ 140), and the 2017 American College of Physicians/American Academy of Family Physicians (Age ≥ 60, intensify when SBP ≥ 150). Varying guideline targets, prescriber inertia, and systemic and patient factors were noted to contribute to the lack of appropriate up-titration.

Growing evidence points to cardiovascular benefits for older adults resulting from tighter control of hypertension; appropriate intensification may prevent major cardiovascular events and mortality.^2-4

Sources

¹Chiu N, Chiu L, Aggarwal R, et al. Trends in blood pressure treatment intensification in older adults with hypertension in the United States, 2008 to 2018. Hypertension. 2023;80(3):553-562. doi:10.1161/HYPERTENSIONAHA.122.19882.

²Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385(14):1268– 1279. doi:10.1056/NEJMoa2111437.

³Wright JT Jr, Whelton PK, Johnson KC, et al. SPRINT revisited: updated results and implications. Hypertension. 2021;78(6):1701-1710. doi:10.1161/HYPERTENSIONAHA.121.17682.

⁴Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065.