Stéphanie Ragot1, Philippe Sosner2, François Dievart3, Daniel Herpin4. 1. Inserm, CIC1402, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Université de Poitiers, CIC1402, 86000 Poitiers, France; Université de Poitiers, UFR médecine et pharmacie, 86000 Poitiers, France. Electronic address: stephanie.ragot@chu-poitiers.fr. 2. CHU de Poitiers, cardiologie, 86000 Poitiers, France; Laboratoire MOVE (EA 6314), université de Poitiers, 86000 Poitiers, France. 3. Clinique Villette, cardiologie, 59240 Dunkerque, France. 4. Université de Poitiers, UFR médecine et pharmacie, 86000 Poitiers, France; CHU de Poitiers, cardiologie, 86000 Poitiers, France.
Abstract
BACKGROUND: The rate of uncontrolled hypertensives aged >80 years is not well known. The available literature on this topic has used the threshold <140/90 mmHg, whereas there is now a consensus for a different target: systolic blood pressure (SBP)<150 mmHg. AIMS: This prospective observational population-based study sought to assess the frequency and management of uncontrolled hypertension in French patients aged ≥80 years. METHODS: Nine hundred and seventy-one treated hypertensive outpatients were evaluable (204 recruited by cardiologists, 767 by general practitioners [GPs]; mean age 84.8 ± 3.8 years; 57.8% women). RESULTS: The frequency of SBP ≥ 150 mmHg was 36.6% (44.6% in cardiologists' patients and 34.4% in GPs' patients). The frequency of satisfaction with SBP ≥ 150 mmHg was 22.0% for cardiologists (32.6% if diastolic blood pressure [DBP] <90 mmHg and 9.5% if ≥90 mmHg; P=0.008) and 30.4% for GPs (51.7% if DBP <90 mmHg and 13.2% if ≥90 mmHg; P<0.0001). Non-diabetic status (for cardiologists) and DBP <90 mmHg (for cardiologists and GPs) were independent determinants of SBP being considered acceptable. Accordingly, in patients with an SBP level ≥ 150 mmHg that was considered too high, treatment was reinforced more often if DBP was ≥90 mmHg (82.3%) than <90 mmHg (68.5%). CONCLUSION: In France, hypertension is uncontrolled in more than one in three elderly hypertensives. Physicians are aware that SBP should be lowered to <150 mmHg in patients aged>80 years, but when the target is not reached they are less likely to increase treatment if DBP is <90 mmHg.
BACKGROUND: The rate of uncontrolled hypertensives aged >80 years is not well known. The available literature on this topic has used the threshold <140/90 mmHg, whereas there is now a consensus for a different target: systolic blood pressure (SBP)<150 mmHg. AIMS: This prospective observational population-based study sought to assess the frequency and management of uncontrolled hypertension in French patients aged ≥80 years. METHODS: Nine hundred and seventy-one treated hypertensive outpatients were evaluable (204 recruited by cardiologists, 767 by general practitioners [GPs]; mean age 84.8 ± 3.8 years; 57.8% women). RESULTS: The frequency of SBP ≥ 150 mmHg was 36.6% (44.6% in cardiologists' patients and 34.4% in GPs' patients). The frequency of satisfaction with SBP ≥ 150 mmHg was 22.0% for cardiologists (32.6% if diastolic blood pressure [DBP] <90 mmHg and 9.5% if ≥90 mmHg; P=0.008) and 30.4% for GPs (51.7% if DBP <90 mmHg and 13.2% if ≥90 mmHg; P<0.0001). Non-diabetic status (for cardiologists) and DBP <90 mmHg (for cardiologists and GPs) were independent determinants of SBP being considered acceptable. Accordingly, in patients with an SBP level ≥ 150 mmHg that was considered too high, treatment was reinforced more often if DBP was ≥90 mmHg (82.3%) than <90 mmHg (68.5%). CONCLUSION: In France, hypertension is uncontrolled in more than one in three elderly hypertensives. Physicians are aware that SBP should be lowered to <150 mmHg in patients aged>80 years, but when the target is not reached they are less likely to increase treatment if DBP is <90 mmHg.