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Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission

Morrissey, Y., Bedford, M., Irving, J., Farmer, Christopher K. (2016) Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission. Age and Ageing, . ISSN 0002-0729. E-ISSN 1468-2834. (doi:10.1093/ageing/afw120)

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Abstract

Background: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension. Aim: the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people. Design: a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent. Results: a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission. Conclusions: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people.

Item Type: Article
DOI/Identification number: 10.1093/ageing/afw120
Uncontrolled keywords: older people, hypotension, hospital admission, acute kidney injury, mortality
Subjects: R Medicine > RC Internal medicine > RC667 Diseases of the circulatory (cardiovascular) system
R Medicine > RC Internal medicine > RC952 Geriatrics
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Chris Farmer
Date Deposited: 06 May 2016 10:38 UTC
Last Modified: 10 Jun 2019 09:58 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/55292 (The current URI for this page, for reference purposes)
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