Are hypertensive elderly patients treated differently?

Amy DG Huebschmann¹, Caroline Bublitz², Robert J Anderson¹

¹University of Colorado-Denver Health Sciences Center (UCDHSC), Department of Internal Medicine, Division of General Internal Medicine, Denver, CO, USA; ²UCDHSC, Primary Care Research Unit, Department of Family Medicine, Denver, CO, USA

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: 332 510 280 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 ≥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.

Keywords: aged, hypertension, therapeutics, drug prescriptions, physician’s practice patterns