Prevalence, Treatment, and Control of Hypertension in the Elderly: Study on Blood Pressure in Elderly Outpatients (SPAA)

The prevalence, quality of care, and degree of control of arterial hypertension have been studied in 3858 elderly outpatients (mean age 72.7 ± 4.9 years) randomly recruited from the practice of 444 general practitioners. Hypertension (defined either as blood pressure [BP] = 160 and/or 90 mmHg and/or the presence of antihypertensive treatment) was found in 67.8% of the screened cohort, with a higher prevalence in females than males (73.1% vs 61.0%) and in the older age group (71.1% in those over 80 years vs 64.8% in the 65–69-year group). The hypertensive status was unknown to both the doctors and the patients in 21.4% of cases. Over 90% of the known hypertensives were on treatment with no age-or sex-related differences, but less than 30% of them had BP < 160/90 mmHg. One drug was prescribed to 50.2% of treated patients, only 5.5% were receiving three or more drugs. Low-dosage treatment schedules were frequently used, often associated with non-daily drug administration. Despite the high proportion of subjects on treatment, hypertension in the elderly we studied seemed to be poorly controlled. The study also documents the need for a more rational approach to detection and control of hypertension in this age group, for whom clearly defined recommendations or criteria are lacking.