Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines

Abstract

The American College of Cardiology and the American Heart Association (ACC/AHA) 2017 guidelines for hypertension management lowered blood pressure (BP) thresholds to 130/80 mmHg to define hypertension while the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) 2018 guidelines retained 140/90 mmHg. Both guidelines recommend adapting management for older patients with complex health conditions, without however clear indications on how to adapt. Our aims were to assess the impact of lowering BP thresholds on the prevalence of elevated BP and BP control, as well as the proportion of participants with a complex health condition across these BP categories. We used data from 3210 participants in the Lausanne cohort Lc65+ aged between 67 and 80 years. Hypertension diagnosis and antihypertensive medication use were self-reported. BP was measured three times at one visit. Some 51% of participants reported having hypertension and 44% reported taking antihypertensive medication. Compared with ESC/ESH thresholds, the prevalence of measured elevated BP was 24% percentage points higher and BP control was 24% percentage points lower using ACC/AHA thresholds. About one out of two participants with elevated BP and four out of five participants with uncontrolled BP had a complex health condition, i.e., frailty, multimorbidity, or polypharmacy. To comply with ACC/AHA guidelines, considerable effort would be required to reach BP control. This is a serious challenge because a large share of hypertensive older adults has complex health conditions, a type of patients for whom there is no strong evidence on how to manage hypertension.

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Funding

The Lc65+ study has been supported by University of Lausanne Hospital Centre; University of Lausanne Department of Ambulatory Care and Community Medicine; Canton de Vaud Department of Public Health; City of Lausanne; Loterie Romande [research grants 2006–2008 and 2018–2019]; Lausanne University Faculty of Biology and Medicine [multidisciplinary research grant 2006]; Swiss National Foundation for Scientific Research [grant 3247B0-120795/1]; and Fondation Médecine Sociale et Préventive, Lausanne. The sponsors had no role in the design, execution, analysis and interpretation of data, or writing of the study.

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Correspondence to Daniela Anker.

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Anker, D., Santos-Eggimann, B., Zwahlen, M. et al. Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines. J Hum Hypertens (2020). https://doi.org/10.1038/s41371-020-0334-4

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