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Antihypertensive Treatment Patterns and Blood Pressure Control in Older Adults: Results from the Berlin Aging Study II

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Abstract

Background

Hypertension is highly prevalent in older adults and represents a major public health issue since recognition, awareness, treatment and control are insufficient. Analyses of prescription patterns in conjunction with clinical parameters can provide novel insights into the current practice of hypertension management and help to identify barriers to sufficient hypertension control.

Methods

A cross-sectional analysis was conducted. Prevalence of hypertension, patterns of antihypertensive therapy, and determinants of blood pressure (BP) control were examined in the Berlin Aging Study II cohort, including 1654 community-dwelling older adults (60–85 years of age).

Results

Of the participants, 75.9% had hypertension; 40.6% of these were not prescribed BP medications. Lack of hypertension awareness, younger age, absence of comorbidities, not being on a statin, and not having visited a physician in the past 3 months were associated with lack of treatment. Forty-two percent of treated hypertensive individuals received monotherapy and 58.0% received combination therapy. Renin–angiotensin–aldosterone system (RAAS) inhibitors, and β-blockers were most commonly prescribed, while calcium channel blockers were least prescribed. Only 38.5% of treated hypertensive individuals had their BP controlled to < 140/90 mmHg. Number and choice of BP medications were not predictive of BP control; neither were age, glycated hemoglobin (HbA1c), kidney function, or number of healthcare visits. However, female sex, lower low-density lipoprotein cholesterol (LDL-C) levels and current smoking, amongst others, were positively associated with BP control. There was evidence of significant effect modification by statins in the association of LDL-C and BP.

Conclusion

The majority of older adults do not reach BP goals. Antihypertensive prescription patterns do not conform to current guidelines. Using more BP medications was not associated with higher odds of BP control. Lowering LDL-C might be favorable in terms of BP control.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, Berlin Institute of Health, Berlin, Germany

    Maximilian König, Ilja Demuth, Dominik Spira & Elisabeth Steinhagen-Thiessen

  2. Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany

    Maximilian König & Maik Gollasch

  3. Experimental and Clinical Research Center (ECRC), A joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association of National Research Centers, Berlin, Germany

    Maik Gollasch

  4. Department of Geriatrics, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, Berlin Institute of Health, Berlin, Germany

    Adrian Rosada

  5. Division of Geriatrics, University Medicine Greifswald, Greifswald, Germany

    Elisabeth Steinhagen-Thiessen

  6. Berlin-Brandenburg Center for Regenerative Medicine (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany

    Ilja Demuth

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  1. Maximilian König
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Correspondence to Maximilian König.

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Funding

The BASE-II study was supported by the German Federal Ministry of Education and Research (grant number 16SV5536 K).

Conflict of interest

Maximilian König, Maik Gollasch, Adrian Rosada, Ilja Demuth, Dominik Spira, and Elisabeth Steinhagen-Thiessen declare that they have no conflicts of interest that might be relevant to the contents of this article.

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König, M., Gollasch, M., Rosada, A. et al. Antihypertensive Treatment Patterns and Blood Pressure Control in Older Adults: Results from the Berlin Aging Study II. Drugs Aging 35, 993–1003 (2018). https://doi.org/10.1007/s40266-018-0580-0

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