Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1024 — The Effect of Age on Hypertension Control and Management

Author List:
Borzecki AM (CHQOER & Boston University)
Glickman ME (CHQOER & Boston University)
Kader B (CHQOER & Boston University)
Berlowitz DR (CHQOER & Boston University)

Objectives:
VA performance measures and guidelines emphasize blood pressure (BP) treatment to a goal of <140/90 mm Hg regardless of age. However, there is little evidence to support this recommendation in those >=80 years of age, and there is controversy as to whether treatment benefits outweigh risks. Whether this uncertainty affects current VA practice is unknown. This study examines: 1) BP control by age among patients with hypertension; 2) the association between number of prescribed antihypertensive medications and age.

Methods:
Cross-sectional study of 59,207 outpatients with hypertension treated at ten VA sites. Outcome measures were BP control (<140/90, yes/no) and number of antihypertensive medications at the patient’s last study visit. BP control by age was modeled using logistic regression, adjusting for gender, race, body mass index, hypertension-related conditions (diabetes, renal disease, coronary, cerebral and peripheral vascular disease, congestive heart failure, atrial fibrillation, and benign prostatic hypertrophy) and number of antihypertensive medications. Number of medications by age was modeled using linear regression adjusting for the same covariates plus BP control instead of medications.

Results:
The mean age was 65.1+11.1. All hypertension-related conditions increased in prevalence with age. For BP control, those aged <40, 40-49 and 50-59 had better control compared to 60-69 year olds (respective adjusted odds ratios 1.21[95% CI 1.03-1.42], 1.46 [CI 1.37-1.56] and 1.27 [CI 1.21-1.34] respectively). Those aged 70-79, and >=80 had worse control (respective odds ratios 0.88 [CI 0.84-0.91] and 0.84 [CI 0.78-0.90]). Antihypertensive medication use increased by successive decade to age 80, then the trend reversed. Adjusted mean number of medications by age were: <40, 2.60+/-1.31; 40-49, 2.82+/-2.05; 50-59, 2.91+/-2.94; 60-69, 3.0+/-3.36; 70-79, 3.03+/3.37; >80, 2.90+/-1.85 (p<0.05 in pairwise comparisons by successive decade).

Implications:
The oldest hypertension patients, despite worse BP control, are being treated less aggressively with fewer medications than their younger counterparts (those 60-79). Our results suggest the current controversy in how aggressively to treat elderly hypertensives is impacting actual VA practice.

Impacts:
Further evidence is necessary to support the VA policy of not considering age with respect to BP goals. Until then, current performance measures may unfairly penalize providers with a large panel of patients 80 and older.