Undertreatment of hypertension in community-dwelling older adults: a drug-utilization study in Dicomano, Italy

Objective To define: (1) the prevalence of and (2) factors associated with undertreatment of hypertension in older persons; and (3) the prevalence of specific drug regimens and reasons for their selection. Participants Cross-sectional survey of persons aged greater than or equal t o 65 years living in Dicomano, Italy, Main outcome measures Prevalence of untreated and uncontrolled hypertension , both defined on the basis of two blood pressure (BP) cut-off points (grea ter than or equal to 140/90 and greater than or equal to 160/90 mmHg) and o f the presence of pharmacological treatment Predictors of undertreatment we re analysed for the higher BP cut-off only, Results Five hundred of 692 (72.3%) and 380/692 (54.9%) participants met th e 140/90 and the 160/90 mmHg BP criterion, respectively, Of the latter, 162 (42.6%) were untreated, 119 (31.3%) had uncontrolled and 99 (26.1%) contro lled hypertension, Women [odds ratio (OR), 0.4; 95% confidence interval (CI ), 0.2-0.7], participants with coronary artery disease (CAD) (OR, 0.2; 95% CI, 0.1 -0.6), stroke (OR, 0.3; 95% CI, 0.1-0.7), and preserved cognitive s tatus (Mini Mental State Examination score > 21:0.3; 95% CI, 0.2-0.7) were more frequently treated. Uncontrolled hypertension was less likely in women (OR, 0.5; 95% CI, 0.3-1.0) and CAD patients (OR, 0.3; 95% CI, 0.1-0.7), An giotensin converting enzyme (ACE)-inhibitors (55%), calcium (Ca)-antagonist s (31%) and diuretics (20%) were the drugs most commonly prescribed. ACE-in hibitors were preferred, and diuretics rarely used, in diabetic subjects. C a-antagonists were used mostly in CAD participants. Conclusions Hypertension is undertreated in the majority of noninstitutiona lized older adults, especially in men with impaired cognition and no vascul ar disease. Drug regimens are mostly based on ACE-inhibitors and Ca-antagon ists, as a result of associated clinical conditions, requiring individualiz ed treatment (C) Lippincott Williams & Wilkins.