Control of Blood Pressure in Hypertensive Patients Regardless of Age

H.D. Radchenko, T.H. Slascheva, Yu.M. Sirenko, L.O. Mushtenko


The objective of our study was to compare the control of blood pressure (BP) in the general Ukrainian population of hypertensive patients aged up to 65 years and older and to assess factors associated with failure to achieve target BP during 3-month antihypertensive treatment, separately in each age group.
The analysis included data from 6758 patients. All patients were divided into two groups depending on age. The first group included 4328 people aged under 65 years, the second group — 2430 persons aged 65 years and older (the elderly according to the WHO classification, 2012). 531 doctors at their discretion administered to the patients with arterial hypertension (AH) antihypertensive drugs in doses they considered necessary to prescribe. Monitoring the effectiveness of treatment occurred in visits — generally 4 visits within 3 months. During visits, patients were measured office BP, underwent electrocardiography, assessment of the adherence to treatment using standard questionnaire, evaluation of cardiovascular risk and surveys according to the questionnaire developed by the authors of the research. Multifactorial regression analysis was used to identify independent predictors of the lack of treatment efficacy.
In people aged 65 years and older, AH was associated with a greater incidence of complications such as heart failure, stroke, myocardial infarction and renal damage, comorbidities (diabetes mellitus, coronary heart disease) and risk factors (obesity, dyslipidemia, high systolic blood pressure (SBP)). Younger patients with AH often have bad habits (smoking, alcohol and salt abuse). However, they often had additional physical activity and rarely ate fresh fruits and vegetables, less than 1 per day. At baseline, only 27.2 % of patients in the first group and 24.8 % in the second one (P < 0.05) had high adherence to treatment. Against the background of therapy, there was a significant improvement of the adherence in both groups: the proportion of patients with low adherence significantly reduced and the share of patients with high and moderate adherence increased. However, at the end of the study, more elderly people were characterized as patients with low adherence. At the end of the study, much younger patients had significantly lower average levels of SBP and diastolic BP than older patients. The target BP (less than 140/90 mmHg) was achieved in 63.7 % of patients in the first group, which was significantly higher than in patients from the second group — 54 % (P < 0.001). Thus, the average number of drugs elderly patients were treated with was significantly higher. Factors associated with a high probability of failure to reach target BP were almost identical for patients in both age groups: higher initial BP level, the presence of hypercholesterolemia, low adherence to treatment at the end of follow-up. In younger patients, additional factors which increased the likelihood of ineffective treatment were: initial low adherence to treatment, greater body mass index and rare intake of fresh vegetables and fruits. In patients aged 65 years and older, the presence of heart failure signs was such additional factor.
So, patients of older age group with AH were characterized by poorer control of BP on the background of therapy. Along with common for both age groups, there were some specific factors associated with the lack of achievement of target BP that must be considered for more effective management of patients of all ages.


arterial hypertension; age; blood pressure control; predictors of the lack of antihypertensive therapy efficacy


Настанова та клінічний протокол надання медичної допомоги «Артеріальна гіпертензія». Наказ МОЗ України № 384 від 24.05.2012. — К., 2012. — 107 с.

Сіренко Ю., Радченко Г., Марцовенко І. від імені учасників дослідження. Результати тримісячного спостереження за лікуванням пацієнтів з артеріальною гіпертензією лікарями загальної практики в Україні // Артеріальна гіпертензія. — 2009. — № 4. — С. 3-14.

2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // Journal of Hypertension. — 2013. — Vol. 31. — P. 1281-1357

Akpaffiong M., Lawson M. Noncompliance to antihypertensive Drug therapy: a risk factor in Stroke-associated death in Minority populations // J. Hypertens. — 2004. — Vol. 17. — P. 68.

Aronow W., Fleg J., Pepine C. et al. ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Developed in Collaboration With the Clinical Expert Consensus Documents American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension // J. Am. Coll. Cardiol. — 2011. — Vol. 57. — P. 2037-2114.

Azizi M., Menard J., Peyrard S. et al. Assessment of patient’s and physician’s compliance to an ACE inhibitor treatment based on urinary N-acetyl Ser-Asp-Lys-Pro determination in the noninsulin-dependent diabetes, hypertension, microalbuminuria, proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study // Diabetes Care. — 2006. — Vol. 29. — P. 1331-1335.

Barrios V., Escobar C., Calderón C. et al. Scientific letters / Clinical Profile and Blood Pressure Control in Patients Managed in Primary Care in Spain: Are There any Differences Between the Young and the Old? // Rev. Esp. Cardiol. — 2013. — Vol. 66 (10). — P. 822-829.

Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials // BMJ. — 2008. — Vol. 336. — P. 1121-1123.

Buabeng K., Matowe L., Plange-Rhule J. Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana // J. Pharm. Sci. — 2004. — Vol. 7. — P. 350-352.

Burnie M. Compliance in hypertension // EDTNA ERCA J. — 2005. — Vol. 31. — P. 152-155.

Colhoun H.M, Doug W., Poulter N.R. Blood pressure screening, management and control in England: results from the health survey for England // J. Hypertens. — 1998. — Vol. 16. — P.747-752.

Contreras E., Guillen V., Martinez J.J. et al Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005 // Aten. Primaria. — 2006. — Vol. 38. — 325-332.

Contreras E., von Wichmann M. de la Figuera, Ponsa L. еt al. Compliance with hypertension therapy in Spain, according to the views of family doctors. Complex project / /Intern. Emerg. Med. — 2006. — Vol. 1. — P. 204-208.

Cutler J.A., Sorlie P.D., Wolz M., Thom T., Fields L.E., Roccella E.J.Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004 // Hypertension. — 2008. — Vol. 818. — P. 827-852.

Daugherty S., Masoudi F., Magid D. Age Dependent Gender Differences in Hypertension Management // Journal of Hypertension. — 2011. — Vol. 29 (5). — P. 1005-1011.

Fodor G., Kotrec M., Bacskai K. Et al. Is interview a reliable method to verify the compliance with antihypertensive therapy? An international central European study // J. Hypertens. — 2005. — Vol. 23. — P. 1261-1266.

Gascon J., Sanchez-Ortunob M., Llorc B. et al. for the Treatment Compliance in Hypertension Study Group. Why hypertensive patients do not comply with the treatment Results from a qualitative study // Family Practice. — 2004. — Vol. 21. — P. 125-130.

Gerbino P., Bramley T., Nightengale B., et al. Effect of medication compliance with antihypertensive therapy on blood pressure control // Am. J. Hypertens. — 2004. — Vol. 17. — P. 222A.

Girerd X., Fourcade J., Brillet G. et al. The compliance evaluation test: a validated tool for detection of nonadherence among hypertensive treated patients // J. Hypertens. — 2001. — Vol. 19. — P. 74S.

Girerd X., Hanon O., Anagnostopoulos K. et al. Evaluation de l’observance du traitement antihypertenseur par un questionnaire: mise au point et utilization dans un service specialize // Presse Med. — 2001. — Vol. 30. — P. 1044-1048.

Lagi A., Rossi A., Passaleva M. et al. Compliance with therapy in hypertensive patients // Intern. Emerg. Med. — 2006. — Vol. 1. — P. 204-208.

Lawes C.M., Hoorn S.V., Rodgers A. Global burden of blood-pressure related disease // Lancet. — 2001. — Vol. 371. — P. 1513-1518.

Mackenzie L.D., Campbell N.C., Murchie P. New NICE guidelines for hypertension Ambulatory monitoring is to become key // BMJ. — 2011. — Vol. 343. — P. d5644. doi: 10.1136/bmj.d5644

Mino-Leon D., Reyes-Morales H., Galvan-Plata M.E. et al. Drug treatment of hypertension: compliance and adverse reactions in a cohort of hypertensive patients in a primary care setting // Rev. Invest. Clin. — 2007. — Vol. 59. — P. 8-14.

Morgado M., Rolo S., Macelo A. Association of statin therapy with blood pressure control in hypertensive hypercholesterolemic outpatients in clinical practice // J. Cardiovasc. Dis. Res. — 2011. — Vol. 2 (1). — P. 44-49.

Rizzo J., Simons W. Variations in compliance among hypertensive patients by drug class: implications for health care costs // Clin. Ther. — 1997. — Vol. 19. — P. 1446-1457.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2012.

Waeber B., Feihl F Arterial hypertension. Factors favoring long-term compliance with therapy // Rev. Med. Suisse. — 2007. — Vol. 3. — P. 22-24.

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