Yvonne Morrissey1, Michael Bedford2, Jean Irving2, Chris K T Farmer2. 1. Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK. 2. Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent CT1 3NG, UK.
Abstract
BACKGROUND: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension. AIM: the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people. DESIGN: a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent. RESULTS: a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission. CONCLUSIONS: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people.
BACKGROUND: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension. AIM: the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people. DESIGN: a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent. RESULTS: a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission. CONCLUSIONS: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people.
Authors: Jonathan M K Bogaerts; Rosalinde K E Poortvliet; Veerle M G T H van der Klei; Wilco P Achterberg; Jeanet W Blom; Ruth Teh; Marama Muru-Lanning; Ngaire Kerse; Anna Rolleston; Carol Jagger; Andrew Kingston; Louise Robinson; Yasumichi Arai; Ryo Shikimoto; Jacobijn Gussekloo Journal: J Hypertens Date: 2022-07-11 Impact factor: 4.776