A systematic review of hypertension outcomes and treatment strategies in older adults

ObjectiveTo evaluate the literature regarding blood pressure control and management in older adult patient population over 70 years of age.MethodsA literature search was conducted using PubMed and capturing the data from 2006 to 2016. Terms used included MeSH headings for hypertension/therapy and antihypertension agents. A systematic review of published studies was performed. Articles including older patients (average age 70 years or older) being treated for hypertension were included. We analyzed the blood pressure goals and treatment regimens along with cardiovascular outcomes.ResultsSix trials were evaluated that met criteria for inclusion. A range of countries were represented including Europe, China, Australia, Tunisia, US, and Japan. The population size in the trials ranged from 142 to 4736. All studies included had adequate power to assess treatment effects. Blood pressure goals were variable and ranged from a systolic of <120 to <160 with a diastolic goal of <80 mmHg. Some studies reported outcomes including all-cause mortality, composite cardiovascular events, cardiovascular mortality, fatal and non-fatal stroke or myocardial infarction, and fatal or nonfatal heart failure. Many trials were stopped early because of the significant findings in mortality and cardiovascular outcomes.ConclusionsThe studies discussed had a range of blood pressure goals. The optimal management of hypertension in older adults is still being debated. Data from the clinical trials show that treating blood pressure to tight goals of at least <140/80, or lower if tolerated, confers benefit in cardiovascular outcomes.     

西藏昂仁县高血压患病率、知晓率、治疗率和控制率的调查

目的调查西藏昂仁县农牧民高血压患病率、知晓率、治疗率和控制率,为西藏地区高血压的防治提供依据。方法采用分层多阶段随机抽样方法,通过调查问卷的形式,在2017年5~9月调查18岁及以上昂仁县农牧区藏族居民的高血压患病情况。结果共调查2158人,平均收缩压为(128.67±25.90)mmHg,平均舒张压为(86.77±16.53)mmHg。高血压患病率为37.81%,知晓率为52.82%,治疗率为45.10%、控制率为6.62%。结论西藏昂仁县农牧民(≥18岁)高血压患病率高,而知晓率、治疗率及控制率较低,需要进一步加强高血压防治工作。     

Impact of a community based intervention program on awareness,treatment and control of hypertension in a rural Panchayat,Kerala, India

ObjectiveCommunity based intervention to control hypertension is extremely limited in India. We conducted this study to find the effectiveness of a community based intervention program on the awareness, treatment and control of hypertension.MethodsA baseline survey was conducted among 4627 adults aged ≥30 years (men 44%) selected by cluster sampling. Information was collected using a structured interview schedule by trained local volunteers. They measured weight, height, waist circumference and blood pressure using standard protocol. The volunteers monitored blood pressure at least once a month and educated the people in neighborhood groups on the need for regular medication and reducing risk factors of hypertension for a period of six years. A post intervention survey was conducted among 2263 adults aged ≥30 years (men 49%). Stepwise logistic regression analysis was done to find the odds of change in awareness, treatment and control of hypertension.ResultsThe odds of awareness (OR 4.18, 95% CI 3.44–5.08), treatment (OR 3.44 CI 2.81–4.22) and control (OR 4.39 CI 3.36–5.73) of hypertension increased significantly in the post intervention survey compared to the baseline survey. Baseline hypertension prevalence of 34.9% (CI 33.8–36.1) was reduced to 31.0% (CI 29.1–32.9) in the post intervention survey based on age adjusted analysis.ConclusionOur community based intervention using trained community based volunteers could increase awareness, treatment and control of hypertension among adult hypertensives.     

Prevalence,awareness, treatment and control of hypertension among adults 50 years and older in Dakar,Senegal

Background

Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, no study on the prevalence, awareness, treatment and control on arterial hypertension in Senegal has been conducted, specifically among elderly people.

Methods

Five hundred people aged 50 years and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive for representativeness of the target population.

Results

Prevalence of hypertension was 65.4% in our sample. Half of those suffering from high blood pressure were aware of their problem and among the latter, 70% said they were on treatment. However, of these, only 17% had controlled arterial blood pressure. The only factor associated with awareness, treatment and control of hypertension was the frequency of doctor visits.

Conclusion

Improving follow-up health checks of older adults are necessary to limit the consequences of hypertension in Dakar.     

广州茶涪街社区高血压病的发病率、知晓率及治疗依从性研究

目的 了解广州市荔湾区茶涪街社区高血压病的发病率、知晓情况及依从性,为进一步做好高血压病的预防提供资料。方法随机抽取该社区住户中年龄≥20岁的居民2420名（社区总人口的8．77％）,给予问卷调查并测量血压。判定高血压的标准为：收缩压≥140mmHg和（或）舒张压≥90mmHg。判定单纯收缩期高血压的标准为收缩压≥140mmHg且舒张压〈90mmng。结果该社区20岁以上人员高血压病的发病率为16．12％,其中58．72％的高血压患者没有认识到自己患有高血压。在既往确诊病例中,70．19％的患者对降压治疗无良好的依从性。单纯收缩期高血压的发病率为4．71％。年龄≥60岁的高血压病患者中有43．56％为单纯收缩期高血压。结论广州市荔湾区茶涪街社区高血压病高发。有超过一半的高血压患者对自己患有高血压病不知晓。在老年高血压患者中,单纯收缩期高血压患者不少。大部分患者依从性差,仅少部分患者可将血压控制在理想水平。在社区内定期对居民血压进行普查并进行宣教是必要的。     

Prevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015

Malaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on socio-demographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (<5 servings/day), high sedentary time, having diabetes, and having mobility impairment were all associated with physical inactivity. Approximately half of the Malaysian older population are physically inactive. Identifying the correlates of physical inactivity among Malaysian older adults will help to develop public health policies and interventions that encourage active living among older people and promote healthy aging in Malaysia.     

中国心内科医师高血压患病、知晓、治疗及控制现状

目的 了解中国心血管内科医师高血压患病、知晓、治疗、控制情况.方法 2008年6月1日至8月31日,在中国大陆31个省、自治区、直辖市对386家综合性医院心内科有执业医师资格的4032例心内科医师开展流行病学调查.结果 高血压患病率为12.1%,且在性别间和年龄组间差异均有统计学意义,高血压患者中知晓者占80.0%,治疗者占75.7%,知晓率和治疗率在年龄组间差异有统计学意义,血压得到控制者占42.4%.结论 在被调查的中国心内科医师人群中高血压有较高的患病率,防治工作仍需进一步加强.     

辽宁省农村地区高血压患病率、知晓率和控制率

目的 评估辽宁省农村地区高血压患者的知晓、治疗、控制现状以及血压分布特征,为开展有效的防控手段提供依据.方法 2008年9-11月,对辽宁省农村卫生适宜技术6个示范县626个村35岁以上农村居民共153 481人开展了高血压知晓、治疗和控制现状方面的筛查和评估.结果 辽宁省农村地区高血压患病粗率为40.6%,标化患病率为38.7%,男女年龄在35～044岁、45～54岁、55～64岁、≥65岁患病率分另0为23.9%、36.6%、49.0%、63.8%和20.7%、40.0%、55.0%、68.9%.高血压患者中,知晓率为56.9%,治疗率为39.7%,控制率为3.9%,接受治疗的高血压患者控制率仅为9.8%.治疗组高血压患者的收缩压和舒张压水平分别高于未治疗组患者8.4 mm Hg(1 nnn Hg=0.133 kPa)和3.4 mm Hg.结论 辽宁省农村高血压患病率高,知晓率、治疗率和控制率低,药物治疗效果较差,急需建立有效的农村高血压综合干预和管理的策略.     

Medication adherence and its associated factors among Chinese community-dwelling older adults with hypertension

Objective

To investigate the factors that influence medication adherence in Chinese community-dwelling older adults with hypertension.

Methods

A cross-sectional study was conducted with a convenience sample of 382 older adults with hypertension recruited from six health centers in Macao, China. Chinese versions of the Morisky 4-Item Self-Report Measure of Medication-Taking Behavior, Fear of Intimacy with Helping Professionals scale and Exercise of Self-care Agency scale were administered to participants.

Results

Participants older than 65 years (β = .118, p = .017), with a low level of education (β = .128, p = .01), who had more than one other common disease (β = .120, p = .015), were on long-term medication (β = .221, p < .001) and who reported higher self-care (β = .188, p = .001), had better medication adherence.

Conclusions

Health care professionals should consider these factors when planning medication regimens for Chinese older adults with hypertension, to enhance medication adherence and improve patient outcomes.     

河北省香河县农村高血压流行与管理水平现状调查

  目的 了解河北省香河县农村高血压患病率、知晓率、治疗率、达标率及影响因素。方法 2011年7—8月对香河县年满35岁的830例农村居民进行血压测量和问卷调查。结果 高血压患病率、知晓率、治疗率和达标率分别为42.4%、54.8%、50.0%与11.9%。logistic回归分析显示影响知晓率和治疗率的主要因素是年龄、BMI、家族史及文化程度,影响达标率的主要因素是年龄、家族史及饮酒。结论 在本调查人群中,高血压患病率高,知晓率、治疗率和达标率低,提示农村高血压防控水平亟待提高。     

The prevalence,circumstances and consequences of unintentional falls among elderly Iranians: A population study

Background and aimFalling threatens the health, independence and quality of life of older adults. Information about characteristics and predisposing factors of falls is essential to develop and implement effective preventing measure. The aim of this study was to examine the prevalence, circumstances and consequences of falls among community-dwelling older adults in Tehran, Iran, and scrutinize factors (e.g. demographics) associated with falls.MethodsA cross-sectional study was conducted in Tehran. A total of 653 individuals aged 65 years and over were selected by a stratified random sampling as representing older adults in Tehran. All required data were collected through face-to-face interviews using questionnaires.ResultsThe prevalence of falls was 39.7% and higher in women than in men. For both sexes, most of the falls occurred in the afternoon (n = 135, 52.1%) and at home (n = 209, 80.7%). One-fourth of the falls (23.2%) occurred in a forward direction, mostly among women (60%). For both sexes, one-third of the causes of falls were loss of balance, mostly among women and the oldest persons. Two-hundred and twelve of the fallers reported injuries. The logistic regression showed that female gender, low education and constant worries about living expenses were significantly associated with falls.ConclusionsThis study may have provided new insights into the characteristics/ circumstances/ consequences of injurious falls and their relation with age, gender and injury severity in Iran. It may be useful for health policy makers and health providers when designing falls intervention and prevention programs at the community level.     

Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

Background Hypertension is a common chronic disease among older adults, and is associated with medical complications and mortality. This study aimed to examine the effects of social network characteristics on the prevalence, awareness, and control of hypertension among older adults. Methods The Korean Social Life, Health, and Aging Project (KSHAP) interviewed 814 ≥ 60-year-old residents and their spouses from a rural township between December 2011 and March 2012 (response rate: 95%). We evaluated the data from 595 participants. Multivariate logistic regression models were used to assess the effects of network characteristics on hypertension. Results We observed strong sex-specific network effects on the prevalence, awareness, and control of hypertension. Among older women, network density was associated with hypertension awareness [odds ratio (OR): 2.63, 95% confidence interval (CI): 1.03–5.37] and control (OR: 1.72; 95% CI: 0.94–3.13). Among older men, large networks were associated with a lower prevalence of hypertension (OR: 0.75; 95% CI: 0.58–0.96). Compared to older women, older men with coarse networks exhibited better hypertension awareness (OR: 0.37; 95% CI: 0.14–0.95) and control (OR: 0.42; 95% CI: 0.19–0.91). Network size interacted with density for hypertension control (P = 0.051), with controlled hypertension being associated with large and course networks. Conclusions A large network was associated with a lower risk for hypertension, and a coarse network was associated with hypertension awareness and control among older men. Older women with dense networks were most likely to exhibit hypertension awareness and control.     

上海市长宁区社区人群原发性高血压患病现况及危险因素的调查

目的 通过对上海市长宁区社区人群的抽样调查,了解其高血压的患病率、知晓率和治疗率,并分析与高血压相关联的主要危险因素.方法：采取整群抽样的方法,随机抽取四个社区,对其中35～91岁且排除继发性高血压的自然人群19 519人 （男性8 673人,女性10 846人） 进行调查分析.结果 （1） 高血压的患病率、知晓率和治疗率分别为39.88%、84.74%和47.93%,三率均为65-91岁组高于35-64岁组（39.88%和22.27%,87.40%和78.74%,49.88%和43.53%,P〈0.05）;（2） 对高血压影响因素进行多因素 Logistic 回归分析,结果显示高血压与年龄、性别 （男性）、体质指数、家庭收入、摄盐量、父母高血压史及本人高脂血症史相关（P值均小于0.001）,年龄、性别、体质指数、父母高血压史、本人高脂血症史的OR值分别为1.064 （1.060-1.068）、1.098 （1.053～1.145）、1.134 （1.121-1.147）、1.831 （1.722～1.947）、1.507 （1.329-1.708）;以家庭年收入5万以下组为参照,5-10万和10万以上组 OR 值分别为 2.349 （1.559-3.540）和 2.462 （1.620-3.742）;以摄盐量 6-12g/d 组为参照,〈6g/d组和〉 12 g/d 组 OR 值分别为0.888 （0.832-0.947）和1.117 （1.016～1.227）.结论上海市长宁区社区人群≥65岁者高血压的患病率较高,而中青年高血压的知晓率和治疗率较低,特别是男性.年龄、男性、体质指数高、嗜盐、家庭收入高、高血压家族史及本人高脂血症史是高血压患病的主要危险因素.     

Hypertension awareness, treatment, and control in chronic kidney disease

Background

Hypertension prevalence, awareness, treatment, and blood pressure control rates in the population with chronic kidney disease are limited. The objective of this study was to determine the state of blood pressure control in patients with chronic kidney disease.

Methods

This is a cross-sectional analysis of data of participants with chronic kidney disease from the Kidney Early Evaluation Program. The Kidney Early Evaluation Program is a national-based health screening program for individuals at high risk for kidney disease conducted in 49 states and the District of Columbia. Of 55,220 adults with kidney disease, 10,813 completed information for demographic and medical characteristics used in the analysis. Predictors of blood pressure control were assessed using multiple logistic regression analysis.

Results

Hypertension prevalence, awareness, and treatment proportions in the screened cohort were high (86.2%, 80.2%, and 70.0%, respectively), but blood pressure control rates were low (13.2%). These proportions increased with advancing stage of kidney disease. Elevated systolic blood pressure accounted for the majority of inadequate control. Male gender (odds ratio [OR] 0.86; 95% confidence interval [CI], 0.75-0.99), non-Hispanic black race (OR 0.76; 95% CI, 0.65-0.89), and body mass index of 30 kg/m² or more (OR 0.83; 95% CI, 0.73-0.94) were inversely related with blood pressure control. Those with stage 3 kidney disease were more likely to have blood pressure at goal than those with stage 1 kidney disease (OR 2.08; 95% CI, 1.55-2.80).

Conclusion

We conclude that despite increased awareness and treatment of hypertension, control rates in these participants are poor. This poor control rate centers around elevated systolic pressure in people who are obese, non-Hispanic black, or male. These data suggest that those who are aware of their kidney disease are more likely to achieve blood pressure control.     

Association between hilliness and walking speed in community-dwelling older Japanese adults: A cross-sectional study

PurposeThis cross-sectional study investigated the association between hilliness and walking speed in community-dwelling older adults, and whether it varied according to their car-driving status.MethodsData were collected from 590 participants aged 65 and older living in Okinoshima Town, Shimane prefecture, Japan, in 2018. Comfortable walking speed (m/s) was objectively assessed. Hilliness was measured by the mean land slope (degree) within a 500-m or 1000-m network buffer around each participant's home using a geographic information system. A multiple linear regression examined whether the land slope was associated with walking speed, adjusted for sex, age, body mass index, smoking habits, alcohol consumption habits, exercise habits, chronic disease, and living arrangements. A stratified analysis by car-driving status was also conducted.ResultsAfter adjusting for all confounders, the land slope within the 500-m or 1000-m network buffer was negatively associated with walking speed (B = -0.007, 95% CI [-0.011, -0.002]; B = -0.007, 95% CI [-0.011, -0.003], respectively). The stratified analysis by car-driving status showed that living in a hilly area was negatively associated with walking speed among non-drivers in the 500-m or 1000-m network buffer (B = -0.011, 95% CI [-0.017, -0.004]; B = -0.012, 95% CI [-0.019, -0.006]), though there were no associations among drivers.ConclusionsA hilly environment is positively associated with slow walking speed in community-dwelling older adults in Japan. Moreover, car-driving status potentially modifies the relationship between living in a hilly environment and slow walking speed.     

Prevalence, correlates, awareness, treatment, and control of hypertension in a middle-aged urban population in Kerala

BACKGROUND: Hypertension is an important cause of cardiovascular morbidity and mortality. METHODS AND RESULTS: We conducted a cross-sectional survey of 314 middle-aged subjects (163 men; age range 40-60 years, mean 49 years) in urban Thiruvananthapuram City. Kerala, to estimate the prevalence of hypertension, examine its correlates, and assess the degree of awareness, treatment, and control of high blood pressure. Blood pressure was measured by a nurse graduate using a mercury column sphygmomanometer and a standardized technique. We used multivariable analyses to examine the sociodemographic and clinical correlates of hypertension. The overall prevalence of hypertension in our sample was 54.5% (men 56.3%, women 52.3%). The factors associated with an increased prevalence of hypertension were higher body-mass index (odds ratio for a value in the top tertile of 2.33, 95% confidence interval: 1.2-4.4), and older age (odds ratio for the age group 55-60 years of 2.65, 95% confidence interval: 1.3-5.6). An occupation involving moderate or greater physical activity was inversely associated with the prevalence of hypertension (odds ratio 0.35, 95% confidence interval 0.13-0.94). Among hypertensives, 39% were aware of the condition, while 29% were treated with blood pressure-lowering medications. Adequate control of elevated blood pressure was achieved in only 30.6% of treated hypertensives. In our community-based sample, over half of all middle-aged individuals were hypertensive, but less than a third were under treatment. Adequate control of hypertension was achieved in less than a third of the treated individuals. CONCLUSIONS: These observations re-emphasize the need for hypertension awareness programs targeting the general public and the increased use of opportunistic blood pressure screening, and underscore the importance of measures to increase the knowledge of current guidelines for the detection and treatment of hypertension among healthcare providers.