Trends in Hypertension Prevalence, Treatment, and Control In a Well-Defined Older Population

To assess medical attention focused on hypertension (HBP) in the elderly, this study examines trends in HBP prevalence, treatment, and control status in a defined population of persons > or = 65 years of age enrolled in a large HMO. Random samples of approximately 400 persons were drawn for the years 1967, 1974, 1981, and 1988. First recorded ambulatory pressures, available on over 90% of subjects in each period, were obtained from medical records. Prevalence of HBP (SBP > or = 160 and/or DBP > or = 95, and/or taking anti-HBP drugs) ranged between 44% to 53%. Proportion with HBP on treatment increased from 25% in 1967 to 60% in 1988 (P<.001); proportion on treatment and controlled (SBP < 160, DBP < 95) increased from 8% to 34% (P<.001). Mean population SBP declined from 155.2 in 1967 to 144.0 in 1988 (P<.001); mean DBP declined from 85.2 to 81.2 (P<.001). Proportion with isolated systolic hypertension (ISH) (SBP > or = 160, DBP < 90) remained unchanged at 12% to 14%. Use of diuretics and adrenergic antagonist agents declined while use of beta blockers and newer classes of anti-HBP drugs increased significantly among treated hypertensives in the 1980s. These findings parallel HBP trends in younger adults from National Health Survey data though we find evidence of a substantial gap in addressing the problem in the elderly, who constitute the population at greatest risk of cardiovascular complications of HBP.