Prevalence, Clinical Correlates, and Treatment of Hypertension in Elderly Nursing Home Residents
Journal - Archives of Internal Medicine
Objective To analyze the patterns of antihypertensivedrug therapy among elderly patients living in nursing homesto elucidate their conformity with consensus guidelines.Subjects and Methods We used a long-term care databasethat merged sociodemographic, functional, clinical, and treatmentinformation on nearly 300000 patients admitted to the facilitiesof 5 US states between 1992 and 1994.Results Hypertension was diagnosed in 80206 patients (meanage, 82.7±7.8 years). The prevalence was higher amongwomen and among blacks. About one fourth of patients had 6 ormore comorbid conditions; 26%, 22%, and 29% had concomitantdiagnoses of coronary heart disease, congestive heart failure,and cerebrovascular disease, respectively. Seventy percent ofpatients were treated pharmacologically. Calcium channel blockerswere the most common agents (26%), followed by diuretics (25%),angiotensin-converting enzyme inhibitors (22%), and -blockers(8%). The relative use of these drugs changed according to thepresence of other cardiovascular conditions. Adjusting for potentialconfounders, the relative odds of receiving antihypertensivetherapy were significantly decreased for the oldest subjects(85 years old: odds ratio, 0.85; 95% confidence interval, 0.81-0.89)and those with marked impairment of physical (odds ratio, 0.77;95% confidence interval, 0.73-0.81) and cognitive (odds ratio,0.67; 95% confidence interval, 0.64-0.70) function.Conclusions Among very old, frail hypertensive patientsliving in nursing homes, the pattern of treatment seems notto follow recommended guidelines; age, functional status, andcomorbidity appear to be important determinants of treatmentchoice.