USE OF ANTIHYPERTENSIVE DRUGS AND TRENDS IN BLOOD-PRESSURE IN THE ELDERLY

Background: During the 1980s data became available from randomized tri als concerning the clear benefits of heating hypertension in the elder ly. In three large communities, we examined the impact of these findin gs on rates of treatment, use of specific antihypertensive drugs, and rates of elevated blood pressure as well as distributions of levels. M ethods: In 1981 the National Institute on Aging initiated population-b ased cohort studies in the residents of three communities who were 65 years and older: East Boston, Mass; Washington and Iowa counties, Iowa ; and New Haven, Conn. Participation rates ranged from 80% to 85% acro ss sites with 10 294 community-dwelling participants in the combined c ohorts. Baseline evaluation included in-home blood pressure assessment and medication inventory. Repeated in-home evaluations occurred 3 and 6 years after baseline and follow-up rates ranged from 71% to 88%. Re sults: Use of antihypertensive drugs increased over time in all three communities: the age- and sex-adjusted rates of use were between 14% a nd 32% higher in 1988 and 1989 relative to 1982 and 1983. Parallel dec lines in the use of thiazide diuretics occurred in all three populatio ns along with large increases in the use of angiotensin-converting enz yme inhibitors and calcium channel blockers. In East Boston and New Ha ven mean systolic blood pressure decreased substantially over time and the prevalence of elevated systolic pressure (greater than or equal t o 160 mm Hg) decreased overall as well as by age and sex. In Iowa the mean levels of systolic blood pressure were lowest at baseline and inc reased slightly. Conclusions: The reported evidence about the benefits of treatment for hypertension in the elderly was followed by substant ial increases in treatment rates. The use of drugs with proven efficac y declined while the use of newer agents with theoretical advantages, not yet tested in clinical trials of mortality, increased. In the Unit ed States, the ongoing therapeutic efforts to lower elevated blood pre ssure in elderly populations may be contributing to the continuing dec line in cardiovascular and stroke mortality.