PREVALENCE, CLINICAL CORRELATES, AND TREATMENT OF HYPERTENSION IN ELDERLY NURSING-HOME RESIDENTS

Background: Hypertension is prevalent in the elderly, but an informati on gap remains regarding the old, frail, individuals with complex cond itions living in longterm care. Objective: To analyze the patterns of antihypertensive drug therapy among elderly patients living in nursing homes to elucidate their conformity with consensus guidelines. Subjec ts aad Methods: We used a long-term care database that merged sociodem ographic, functional, clinical, and treatment information on nearly 30 0 000 patients admitted to the facilities of 5 US states between 1992 and 1994. Results: Hypertension was diagnosed in 80 206 patients (mean age, 82.7 +/- 7.8 years). The prevalence was higher among women and a mong blacks. About one fourth of patients had 6 or more comorbid condi tions; 26%, 22%, and 29% had concomitant diagnoses of coronary heart d isease, congestive heart failure, and cerebrovascular disease, respect ively. Seventy percent of patients were treated pharmacologically. Cal cium channel blockers were the most common agents (2%), followed by di uretics (25%), angiotensin-converting enzyme inhibitors (22%), and bet a-blockers (8%). The relative use of these drugs changed according to the presence of other cardiovascular conditions. Adjusting for potenti al confounders, the relative odds of receiving antihypertensive therap y were significantly decreased for the oldest subjects (greater than o r equal to 85 years old: odds ratio, 0.85; 95% confidence interval, 0. 81-0.89) and those with marked impairment of physical (odds ratio, 0.7 7; 95% confidence interval, 0.73-0.81) and cognitive (odds ratio, 0.67 ; 95% confidence interval, 0.64-0.70) function. Conclusions: Among ver y old, frail hypertensive patients living in nursing homes, the patter n of treatment seems not to follow recommended guidelines; age, functi onal status, and comorbidity appear to be important determinants of tr eatment choice.