[en] Background
In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision.
Methods
Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP.
Results
The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs’ decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48–0.59; ORs per country 0.11–1.78).
Conclusions
Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.
Disciplines :
Geriatrics
Author, co-author :
Streit, Sven; Institute of Primary Health Care (BIHAM), University of Bern
Verschoor, Marjolein; Institute of Primary Health Care (BIHAM), University of Bern
Rodondi, Nicolas; Institute of Primary Health Care (BIHAM), University of Bern
Bonfim, Daiana; Hospital Israelita Albert Einstein
Burman, Robert A.; Vennesla Primary Health Care Centre
Collins, Claire; Irish College of General Practitioners
Kitanovska Biljana, Gerasimovska; University Clinical Centre, University St. Cyril and Metodius > Department of Nephrology and Department of Family Medicine,
Gintere, Sandra; Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University
Gomez Bravo, Raquel ; University of Luxembourg > Faculty of Language and Literature, Humanities, Arts and Education (FLSHASE) > Integrative Research Unit: Social and Individual Development (INSIDE)
Hoffmann, Kathryn; Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna
Iftode, Claudia; Timis Society of Family Medicine, Sano Med West Private Clinic
Johansen, Kasper L.; Danish College of General Practitioners
Kerse, Ngaire; School of Population Health, University of Auckland
Koskela, Tuomas H.; Department of General Practice, University of Tampere
Kreitmayer Peštić, Sanda; Family Medicine Department, Health Center Tuzla, Medical School, University of Tuzla
Kurpas, Donata; Family Medicine Department, Wroclaw Medical University
Mallen, Christian D.; Primary Care and Health Sciences, Keele University
Maisoneuve, Hubert; Primary Care Unit, Faculty of Medicine, University of Geneva
Merlo, Christoph; Institute of Primary and Community Care Lucerne (IHAM)
Mueller, Yolanda; Institute of Family Medicine Lausanne (IUMF)
Muth, Christiane; Institute of General Practice, Goethe-University
Petek Šter, Marija; Department for Family Medicine, Medical faculty, University of Ljubljana
Petrazzuoli, Ferdinando; Centre for Primary Health Care Research, Lund University > Department of Clinical Sciences in Malmö
Rosemann, Thomas; Institute of Primary Care, University Hospital Zurich, University of Zurich
Sattler, Martin; SSLMG, Societé Scientifique Luxembourgois en Medicine generale