Are hypertensive elderly patients treated differently?

OBJECTIVES

1. To determine if there are differences in the classes of antihypertensive agents prescribed for the elderly population as compared with younger patients. 2. To compare patterns of antihypertensive therapy with established national guidelines.

DESIGN

National Ambulatory Medical Care Survey (NAMCS) database analysis from 1995-2000.

SETTING

Multiple outpatient clinic settings in the US.

PARTICIPANTS

Primary care and sub-specialty physicians and their patients.

MEASUREMENTS

332510280 outpatient visits with an ICD-9 code corresponding to a diagnosis of hypertension were analyzed. The class(es) of antihypertensive medications that patients were already taking and/or those added in that visit were noted. Demographics of the patients were also analyzed.

RESULTS

There was a statistically significant association between the prescription of diuretics, calcium-channel blockers (CCBs), alpha-1-blockers (A1Bs), alpha-2 agonists (A2Ags) and age > or = 65 years.

CONCLUSION

Patients aged 65 and over were prescribed different types of medications than those under age 65. Increased usage of diuretics and CCBs were in accordance with evidence-based guidelines for this group. A1Bs were likely used more due to co-morbid benign prostatic hyperplasia (BPH), but this is not certain. The increased prescription of A2Ags likely reflects long-term usage of these medications, which nonetheless may be hazardous due to their potential for causing increased cognitive dysfunction in the aged.