R. Marchioli et al., CHANGES IN ANTIHYPERTENSIVE TREATMENT IN THE ELDERLY DURING THE 1980S- THE GAP BETWEEN RESEARCH FINDINGS AND GENERAL-PRACTICE, Cardiology in the elderly, 4(4), 1996, pp. 139-143
Objective and design To assess the development of anti hypertensive th
erapy th rough the 1980s in a sample of elderly outpatient followed pr
ospectively from 1983 to 1988 by Italian general practitioners, in ord
er to highlight the main changes in antihypertensive treatment in gene
ral practice while the results of the first specific trials on the eff
icacy of treating hypertension in the elderly and new antihypertensive
drugs were becoming available. Results A total of 205 general practit
ioners enrolled a random sample of 1907 outpatients aged 65 years or o
lder (44.2% men, mean age 72.7 +/- 4.8 years), Of the 1246 subjects wh
o completed the 5-year follow-up, 849 (68.1%) had high blood pressure
(greater than or equal to 160/90 mmHg) or were prescribed antihyperten
sive drugs at the baseline assessment and 888 (71.3%) at year 5 of fol
low-up. Hypertensive patients were only slightly more frequently treat
ed in 1988 than 1983 (79.4 versus 75.9%), The prevalence of treated hy
pertensives whose condition was well controlled by treatment (blood pr
essure < 160/90 mmHg) did not change significantly after 5 years and w
as still disappointingly low in 1988 (30.8% in 1983, 33.0% in 1988), I
n 1983 and 1988 diuretics were the first-choice drug, although their u
sage had slightly decreased in 1988 (85.1% of treated hypertensives in
1983 versus 71.6% in 1988). However, calcium antagonists and angioten
sin converting enzyme (ACE) inhibitors, prescribed to only 1.7 and 1.2
%, respectively, in 1983, were the antihypertensive drugs mast used af
ter diuretics in 1988 (24.8 and 19.0%, respectively) and replaced the
older drugs (central adrenergic inhibitors and adrenergic neuron block
ers), Conclusions Our study suggests that the positive results of the
first trials on the efficacy of antihypertensive treatment in the elde
rly had marginal epidemiological impact, In the meantime, new drugs, s
uch as calcium antagonists and ACE inhibitors, appear to have replaced
the 'old' therapies without really contributing to better control of
hypertension.