Hypertension in elderly and general practice: French clinicians attitudes

The aim of the study was to assess the management of elderly hypertensives in general practice. A sample of 2 727 general practitioners filled a speci ally designed questionnaire between February and March 1998 in France, Area s covered by the questionnaire included risk of hypertension, blood pressur e measurement and treatment. Most respondents (97%) considered that hypertension remains a cardiovascula r risk factor in elderly but 4% thought that hypertension is usefull by imp roving target organ perfusion. Fifgty-five percent recorded both standing a nd supine measurement, 34% reported measuring blood pressure with patient s upine only. All respondents reported that they would start antihypertensive treatment on the basis of blood pressure level. A minimum systolic level o f 160 and 180 mmHg was given by 65% and 27% practioners respectively while 2% required a minimum level ranging from 139 to 149 mmHg. Among the respond ents who considered that isolated systolic hypertension is pathological (74 %), 73% and 19% used 160 and 180 mmHg as cut-off respectively. Among those who considered that isolated systolic hypertension is physiological (23%), 43% and 46% initiated treatment above 160 and 180 mmHg, respectively. A min imum diastolic level of 90 mmHg was reported by many respondents (61%) whil e 34% required a cut-off level of 100 mmHg. Comparison of systolic and dias tolic levels showed that 49% practioners started antihypertensive therapy a bove 160/90 mmHg and 16% above 180/100 mmHg. Less than 1% reported a thresh old level of 140/90 mmHg. Most practioners (85%) treated hypertensive patie nts regardless of their age. The others treated patients younger than 65 ye ars old (3%), 70 (2%), 80 (5%) and 90 (4%). All respondents reported that t hey would treat their patients to prevent Vascular complications, mainly ce rebrovascular (96%), cardiac (89%) and kidney (75%) disease. In conclusion, for all general practioners, hypertension remains a cardiova scular risk factor in elderly and hypertensive therapy is beneficial to pre vent cardiovascular complications. This study reveals some inter-physician variability in blood pressure measurement and treatment. The risk of standi ng blood pressure fall is not taken into account by 66 % of respondents. Va riability in age threshold is in accordance with the lack of published data on benefice of hypertensive treatment in the very old. The risk of isolate d systolic hypertension is under-estimated by 27% of physicians who reporte d a minimum systolic blood pressure level of 180 mmHg to initiate therapy.