Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents

Giovanni Gambassi, Università Cattolica del Sacro Cuore, Campus di Roma
Kate Lapane, Brown University
Antonio Sgadari, Università Cattolica del Sacro Cuore, Campus di Roma
Francesco Landi, Università Cattolica del Sacro Cuore, Campus di Roma
Pierugo Carbonin, Università Cattolica del Sacro Cuore, Campus di Roma
Anne Hume, University of Rhode Island
Lewis Lipsitz, Harvard Medical School
Vincent Mor, Brown University
Roberto Bernabei, Università Cattolica del Sacro Cuore, Campus di Roma


Background: Hypertension is prevalent in the elderly, but an information gap remains regarding the old, frail, individuals with complex conditions living in long-term care. Objective: To analyze the patterns of antihypertensive drug therapy among elderly patients living in nursing homes to elucidate their conformity with consensus guidelines. Subjects and Methods: We used a long-term care database that merged sociodemographic, functional, clinical, and treatment information on nearly 300 000 patients admitted to the facilities of 5 US states between 1992 and 1994. Results: Hypertension was diagnosed in 80 206 patients (mean age, 82.7 ± 7.8 years). The prevalence was higher among women and among blacks. About one fourth of patients had 6 or more comorbid conditions; 26%, 22%, and 29% had concomitant diagnoses of coronary heart disease, congestive heart failure, and cerebrovascular disease, respectively. Seventy percent of patients were treated pharmacologically. Calcium channel blockers were the most common agents (26%), followed by diuretics (25%), angiotensin-converting enzyme inhibitors (22%), and β-blockers (8%). The relative use of these drugs changed according to the presence of other cardiovascular conditions. Adjusting for potential confounders, the relative odds of receiving antihypertensive therapy were significantly decreased for the oldest subjects (≥85 years old: odds ratio, 0.85; 95% confidence interval, 0.81-0.89) and those with marked impairment of physical (odds ratio, 0.77; 95% confidence interval, 0.73-0.81) and cognitive (odds ratio, 0.67; 95% confidence interval, 0.64-0.70) function. Conclusions: Among very old, frail hypertensive patients living in nursing homes, the pattern of treatment seems not to follow recommended guidelines; age, functional status, and comorbidity appear to be important determinants of treatment choice.