Control of Blood Pressure in Hypertensive Patients Regardless of Age
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.
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