PP.10.21: ANTIHYPERTENSIVE CARE IN THE OLDEST OLD AGED 90 YEARS AND OVER. (June 2015) - Bohlender, J.
Abstract : Objective: The prevalence of hypertension increaes dramatically with age but reliable data on blood pressure and its treatment in the oldest old aged >89 years are lacking. To gain insight into and improve the quality of hypertension care in these patients we analysed the characteristics, blood pressure (BP) and antihypertensive treatment of those admitted to a primary care hospital in Germany. Design and method: All patients admitted to the medical ward aged >89 years were prospectively included over a 12 months period ending 2010. Within an extended cardiovascular risk profiling offered to those >59 years, patients had sitting BP taken at hospital admission with an ECG and blood tests; fasting serum lipid measurements were >2 days thereafter. Antihypertensive treatment followed German guidelines. Follow-up sitting BP was obtained in the morning before drug intake. Patients with septic or circulatory shock and re-admissions were excluded. Results: N = 58 patients aged 92 ± 3 years (mean ± SD; 90–101) with in average 11 (median; 4–32) hospital days were included (77.6% female, 34.5% diabetics, 24.1% atrial fibrillation, 41.4% coronary heart disease). Main diagnoses were diabetes, non-septic infections, heart insufficiency, orthopedic pain and neuro-cognitive impairment. Admission systolic BP was 149 ± 29 mmHg (n = 16 >159 mmHg), diastolic BP 88 ± 31 mmHg, heart rate (HR) 87 ± 15/min, weight 62.1 ± 11.6 kg, serum creatinine 112 ± 48 micromol/l, total cholesterol 4.9 ± 1.2 mmol/l, blood hemoglobin 7.8 ± 1.2 mmol/l. Mid-term BP was 128 ± 22/72 ± 9 mmHg (HR 76 ± 9/min). Discharge BP was 128 ± 17/72 ± 9 mmHg (none >159 mmHg) and HR 73 ± 6/min (BP 21 ± 43/17 ± 35 mmHg and HR 16 ± 22/min lower vs. admission, p < 0.01). Mean antihypertensives/patient (admission vs. discharge) excluding diuretics was 1.0 ± 0.9 vs. 1.1 ± 0.9 (p = NS), including diuretics 1.5 ± 1.2 vs. 1.7 ± 1, 1 (p < 0.05): blockers of B-adrenoceptors 22.4% vs. 25.9%, Ca-channels 8.6% vs. 12.1%, the renin-angiotensin system (RAS) 63.8% vs. 63.8%; spironolactone 5.2% vs. 5.2%, others 1.7% vs. 3.4% (p = NS); diuretics 48.3% vs. 67.2% (p < 0.05); treated patients excluding diuretics 67.2 % vs. 70.7% (any change 43.1%), including diuretics 75.9% vs. 86.2%. There were no sex differences (p = NS). Conclusions: Ambulatory BP treatment was usually by <3 drugs, mainly adrenoceptor- and RAS-blockers or diuretics. Hospitalisation increased the use of diuretics while hospital discharge BP was well controlled.