Hypertension management and control in older persons on admission to an acute care setting

Background: Despite good evidence that managing hypertension in older adults reduces mortality and morbidity,there are limited data regarding current practices in the management of hypertension in older people.Objectives: The aims of this study were to explore the management of hypertension in older people and to identify factors associated with sub-optimal blood pressure (BP) control in older population.Methods: A retrospective cross-sectional study of 503 patients aged ≥65 years admitted to a large metropolitan teaching hospital in New South Wales, Australia,was conducted. The main outcome measures were BP control and antihypertensive medication use. Patients were considered to be at target BP control if they met the current national guideline for the management of hypertension. A block entry logistic regression model was used, and all factors significant in the univariate analysis were included in one step in the multivariate model. Statistical significance was considered at a probability value of <0.05.Results: Sixty-nine percent (n =347) of the study population had a documented diagnosis of hypertension.Of these, 54.5% were at target BP levels on admission to hospital. The median number (±IQR) of antihypertensive agents per patient was 2.0 (1.0–2.0). AngiotensinII receptor blockers were the most commonly used medication type, followed closely by ACEI and CCB. Male gender (OR=1.71, 1.07–2.74), increasing number of antihypertensive medications (OR=1.95,1.15–3.32) and past history of a myocardial infarction(OR=1.28, 1.03–1.60) were all associated with better BP control in older population with hypertension.Conclusions: In conclusion, while older hypertension patients are receiving antihypertensive pharmacotherapy,many older adult patients do not have optimal hypertension control and are not reaching target BP levels. Multidisciplinary healthcare services including clinical pharmacists may potentially improve hypertension management and antihypertensive medication prescription in older persons with hypertension.