TRENDS IN HYPERTENSION PREVALENCE, TREATMENT, AND CONTROL - IN A WELL-DEFINED OLDER POPULATION

To assess medical attention focused on hypertension (HBP) in the elder ly, this study examines trends in HBP prevalence, treatment, and contr ol status in a defined population of persons greater than or equal to 65 years of age enrolled in a large HMO. Random samples of approximate ly 400 persons were drawn for the years 1967, 1974, 1981, and 1988. Fi rst recorded ambulatory pressures, available on over 90% of subjects i n each period, were obtained from medical records. Prevalence of HBP ( SBP greater than or equal to 160 and/or DBP greater than or equal to 9 5, and/or taking anti-HBP drugs) ranged between 44% to 53%. Proportion with HBP on treatment increased from 25% in 1967 to 60% in 1988 (P<.0 01); proportion on treatment and controlled (SBP<160, DBP<95) increase d from 8% to 34% (P<.001). Mean population SBP declined from 155.2 in 1967 to 144.0 in 1988 (P<.001); mean DBP declined from 85.2 to 81.2 (P <.001), Proportion with isolated systolic hypertension (ISH) (SBP grea ter than or equal to 160, DBP<90) remained unchanged at 12% to 14%. Us e of diuretics and adrenergic antagonist agents declined while use of beta blockers and newer classes of anti-HBP drugs increased significan tly among treated hypertensives in the 1980s. These findings parallel HBP trends in younger adults from National Health Survey data though w e find evidence of a substantial gap in addressing the problem in the elderly, who constitute the population at greatest risk of cardiovascu lar complications of HBP.